Individual
MACIE J FAZAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12800 N LAKE SHORE DR, MEQUON, WI 53097-2418
(262) 243-5700
Mailing address
N68W6976 CLEVELAND ST, CEDARBURG, WI 53012-1832
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/21/2026
Last updated
04/21/2026
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