# NORTHEAST OBGYN SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508936154
- **Authorized official:** DR. GARY P FAIT MD (PRESIDENT)
- **Authorized official phone:** (414) 228-8888

## Contact information

- **Practice address:** 7040 N PORT WASHINGTON RD, SUITE 400, GLENDALE, WI 53217-3838
- **Practice address phone:** (414) 228-8888
- **Practice address fax:** (414) 228-8390
- **Mailing address:** 7040 N PORT WASHINGTON RD, SUITE 400, GLENDALE, WI 53217-3838
- **Mailing address phone:** (414) 228-8888
- **Mailing address fax:** (414) 228-8390

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | WI | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/09/2006
- **Last updated:** 08/13/2021