Organization
FAIRHAVEN OBSTETRICS & GYNECOLOGY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GAYLE J BORKOWSKI M.D. (PRESIDENT)
(574) 533-0348
Entity
Organization
Contact information
Practice address
1111 LIGHTHOUSE LANE, GOSHEN, IN 46526-3824
(574) 533-0348
(574) 533-0277
Mailing address
1111 LIGHTHOUSE LANE, GOSHEN, IN 46526-3824
(574) 533-0348
(574) 533-0277
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
363LW0102X
Women's Health Nurse Practitioner
—
—
367A00000X
Advanced Practice Midwife
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100111950
—
IN
01
—
CB5226
RAILROAD MEDICARE
IN
Enumeration date
07/11/2006
Last updated
07/07/2009
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