Healthcare Provider Details

I. General information

NPI: 1306821608
Provider Name (Legal Business Name): PHILIP FARIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 HADLEY RD
MOORESVILLE IN
46158-1788
US

IV. Provider business mailing address

1199 HADLEY RD
MOORESVILLE IN
46158-1788
US

V. Phone/Fax

Practice location:
  • Phone: 317-831-2273
  • Fax: 317-831-9347
Mailing address:
  • Phone: 317-831-2273
  • Fax: 317-831-9347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01025341
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: