Provider Demographics
NPI:1538572615
Name:FORTE, GINA MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:MARIE
Last Name:FORTE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8540 GREENWAY BLVD APT 205
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-4705
Mailing Address - Country:US
Mailing Address - Phone:301-801-6190
Mailing Address - Fax:
Practice Address - Street 1:8540 GREENWAY BLVD APT 205
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-4705
Practice Address - Country:US
Practice Address - Phone:301-801-6190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI689832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program