Organization
CLINIC OF OBSTETRICS AND GYNECOLOGY, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLENDA LEE M.D. (OWNER/PRESIDENT)
(414) 545-8808
Entity
Organization
Contact information
Practice address
8905 W LINCOLN AVE, STE. 407, WEST ALLIS, WI 53227-2468
(414) 545-8808
(414) 545-4920
Mailing address
8905 W LINCOLN AVE, STE. 407, WEST ALLIS, WI 53227-2468
(414) 545-8808
(414) 545-4920
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32832400
GROUP MEDICAID
WI
Enumeration date
02/17/2006
Last updated
09/30/2010
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