Healthcare Provider Details

I. General information

NPI: 1801861422
Provider Name (Legal Business Name): CLINIC OF OBSTETRICS AND GYNECOLOGY, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8905 W LINCOLN AVE STE. 407
WEST ALLIS WI
53227-2468
US

IV. Provider business mailing address

8905 W LINCOLN AVE STE. 407
WEST ALLIS WI
53227-2468
US

V. Phone/Fax

Practice location:
  • Phone: 414-545-8808
  • Fax: 414-545-4920
Mailing address:
  • Phone: 414-545-8808
  • Fax: 414-545-4920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: GLENDA LEE
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 414-545-8808