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General NPI Number Information
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NPI Number | 1598863573
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Entity Type | Organization
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Legal Business Name | MIDWEST CENTER FOR WOMENS HEALTH S.C.
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 05/19/2009
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Provider Practice Location Address
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Address Line | 10222 74TH STREET SUITE 200
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City | KENOSHA
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State | WI
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Zip | 53142-6800
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Country | US
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Telephone | 262-697-9200
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Fax | 262-697-9206
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Provider Business Mailing Address
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Address Line | 10222 74TH STREET SUITE 200
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City | KENOSHA
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State | WI
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Zip | 53142-6800
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Country | US
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Telephone | 262-697-9200
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Fax | 262-697-9206
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. LEONARD S FAGON
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Credential | MD
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Telephone | 262-697-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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