Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Northeast OBGYN SC

Organization Obstetrics & Gynecology Physician · NPI 1508936154

Northeast OBGYN SC is an Obstetrics & Gynecology Physician in Glendale, Wisconsin. Licensed in Wisconsin. Registered with an NPI since 2006.

Licensed in
WI
In the registry since
2006
Specialties on file
2

Practice location Address checks out

7040 N Port Washington Rd Ste 400
Glendale, WI 53217-3838
Phone: (414) 228-8888
Fax: (414) 228-8390
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Obstetrics & Gynecology Physician (primary) Taxonomy 207V00000X
Obstetrics & Gynecology Physician Taxonomy 207V00000X (WI)

Record details

NPI number1508936154
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Gary Fait — President · (414) 228-8888
NPI enumeratedNovember 9, 2006
Last updated in NPPESAugust 13, 2021
Certification dateAugust 13, 2021
Mailing address7040 N Port Washington Rd, Suite 400, Glendale, WI 53217-3838

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