Provider Demographics
NPI:1598850299
Name:OBSTETRICS & GYNECOLOGY, S.C.
Entity Type:Organization
Organization Name:OBSTETRICS & GYNECOLOGY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DORSEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:414-778-0070
Mailing Address - Street 1:3040 N 117TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-4128
Mailing Address - Country:US
Mailing Address - Phone:414-778-0070
Mailing Address - Fax:414-778-0359
Practice Address - Street 1:3040 N 117TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-4128
Practice Address - Country:US
Practice Address - Phone:414-778-0070
Practice Address - Fax:414-778-0359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty