Individual
MARK W FAUSTICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1531 S MADISON ST, APPLETON, WI 54915-1800
(920) 730-4413
Mailing address
1531 S MADISON ST, APPLETON, WI 54915-1800
(920) 730-4413
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
27201
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30732500
—
WI
Enumeration date
09/08/2005
Last updated
08/30/2008
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