MEDICARE: DR. PHILIP FARIS M.D.

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	207X00000X	Orthopaedic Surgery Physician	01025341	IN

General Provider Information

NPI Number	:	1306821608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP FARIS M.D.

Provider Business Mailing Address
First Line	:	1199 HADLEY RD
Second Line	:
City	:	MOORESVILLE
State	:	IN
Zip	:	46158-1788
Country	:	US
Telephone Number	:	317-831-2273
Fax Number	:	317-831-9347

Provider Business Practice Location Address
First Line	:	1199 HADLEY RD
Second Line	:
City	:	MOORESVILLE
State	:	IN
Zip	:	46158-1788
Country	:	US
Telephone Number	:	317-831-2273
Fax Number	:	317-831-9347

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

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	09/10/2012

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