Healthcare Provider Details

I. General information

NPI: 1649497371
Provider Name (Legal Business Name): DANIEL ALLEN FABER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15111 TWELVE OAKS CENTER DR
MINNETONKA MN
55305
US

IV. Provider business mailing address

982055 NEBRASKA MEDICAL CTR
OMAHA NE
68198-2055
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-4500
  • Fax:
Mailing address:
  • Phone: 402-559-7268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5022
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5022
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: