NPI 1083559603

Macie J Fazal

Practitioner Student in an Organized Health Care Education/Training Program Mequon, WI

Practice location

Address: 12800 N Lake Shore Dr, Mequon, WI 53097-2418
Phone: (262) 243-5700
Mailing address: N68w6976 Cleveland St, Cedarburg, WI 53012-1832

Registered specialties (2)

Student in an Organized Health Care Education/Training Program Primary

Student, Health Care Taxonomy 390200000X

Other Student in an Organized Health Care Education/Training Program providers in Wisconsin →

Athletic Trainer

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 2255A2300X

Other Specialist/Technologist providers in Wisconsin →

Registry record

NPI: 1083559603
Entity type: Individual
Sex (as registered): Female
NPI issued: 21 Apr 2026
Record last updated: 21 Apr 2026

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.