Organization
MIDWEST CENTER FOR WOMENS HEALTH S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEONARD S FAGON MD (PRESIDENT)
(262) 697-9200
Entity
Organization
Contact information
Practice address
10222 74TH STREET, SUITE 200, KENOSHA, WI 53142-6800
(262) 697-9200
(262) 697-9206
Mailing address
10222 74TH STREET, SUITE 200, KENOSHA, WI 53142-6800
(262) 697-9200
(262) 697-9206
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21289900
—
WI
Enumeration date
09/21/2006
Last updated
05/19/2009
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