Provider Demographics
NPI:1447567664
Name:MICHAEL C. FASCHING, M. D. P. A.
Entity Type:Organization
Organization Name:MICHAEL C. FASCHING, M. D. P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:FASCHING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-577-7500
Mailing Address - Street 1:2805 CAMPUS DR
Mailing Address - Street 2:SUITE 335
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-2676
Mailing Address - Country:US
Mailing Address - Phone:763-577-7500
Mailing Address - Fax:763-577-7545
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27323208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN097392100Medicaid
MN097392100Medicaid