Provider Demographics
NPI:1699959775
Name:NORTHSHORE GYNECOLOGY ASSOCIATES
Entity type:Organization
Organization Name:NORTHSHORE GYNECOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:G
Authorized Official - Last Name:WESTREICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-243-7470
Mailing Address - Street 1:5128 N 64TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-4005
Mailing Address - Country:US
Mailing Address - Phone:414-527-2521
Mailing Address - Fax:414-527-0638
Practice Address - Street 1:13133 N PORT WASHINGTON RD
Practice Address - Street 2:204
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-2419
Practice Address - Country:US
Practice Address - Phone:262-243-7470
Practice Address - Fax:262-243-7332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-25
Last Update Date:2007-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI38544174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIF28906Medicare UPIN
WIG91959Medicare UPIN
WIG47646Medicare UPIN
WIF28907Medicare UPIN