NORTHEAST OBGYN SC NPI 1508936154

NPI Information

  • NPI: 1508936154
  • Provider Name: NORTHEAST OBGYN SC
  • Classification: Obstetrics & Gynecology - 207V00000X
  • Entity Type: Organization
  • CLIA Number: 52D0391181
  • Address: 7040 N PORT WASHINGTON RD
    SUITE 400
    GLENDALE, WI
    ZIP 53217
  • Phone: (414) 228-8888

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NPI Details

NORTHEAST OBGYN SC is an obstetrics gynecology in Glendale, WI. The provider is an obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. NORTHEAST OBGYN SC NPI is 1508936154. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

7040 N PORT WASHINGTON RD
SUITE 400
GLENDALE, WI
ZIP 53217-838
Phone: (414) 228-8888
Fax: (414) 228-8390

The provider's authorized official is Gary P Fait .
The authorized official title is President and has the following contact phone number (414) 228-8888.

The CLIA number assigned to this NPI record is 52D0391181 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 11/9/2006 and was last updated on 8/13/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207V00000XObstetrics & GynecologyWISCONSINNo
2207V00000XObstetrics & GynecologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
131388400MEDICAIDWISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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