MEDICARE: EDWARD C FARKAS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	36059823	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528048816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD C FARKAS MD

Provider Business Mailing Address
First Line	:	PO BOX 2358
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61834-2358
Country	:	US
Telephone Number	:	217-443-5000
Fax Number	:	217-477-2722

Provider Business Practice Location Address
First Line	:	812 N LOGAN AVE
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61832-3752
Country	:	US
Telephone Number	:	217-443-5000
Fax Number	:	217-477-2722

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	09/13/2007

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