Provider Demographics
NPI:1669797122
Name:FORGIE, MARIE MONA (DO)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:MONA
Last Name:FORGIE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:MONA
Other - Last Name:SCOBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11120 W GILBERT AVE
Mailing Address - Street 2:UNIT F
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2255
Mailing Address - Country:US
Mailing Address - Phone:510-579-5633
Mailing Address - Fax:
Practice Address - Street 1:1020 N 12TH ST
Practice Address - Street 2:OB/GYN DEPARTMENT
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1308
Practice Address - Country:US
Practice Address - Phone:414-219-5725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-28
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI56970-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100031128Medicaid