Provider Demographics
NPI:1346271988
Name:FASCHING, MICHAEL CLOUD (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CLOUD
Last Name:FASCHING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 TONKAWA RD
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-9377
Mailing Address - Country:US
Mailing Address - Phone:952-471-0079
Mailing Address - Fax:
Practice Address - Street 1:2805 CAMPUS DR
Practice Address - Street 2:SUITE 335
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2676
Practice Address - Country:US
Practice Address - Phone:763-577-7500
Practice Address - Fax:763-577-7545
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27323208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MND85338Medicare UPIN