MEDICARE: ALAN FARK 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	207Q00000X	Family Medicine Physician	35.093391	OH

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
2	MI430448957	OTHER	MI	BLUE CROSS PIN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	AF048957	OTHER	MI	BLUE SHIELD PIN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427192863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN FARK MD

Provider Business Mailing Address
First Line	:	3802 PAXTON AVE STE 1
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45209-2399
Country	:	US
Telephone Number	:	513-559-9700
Fax Number	:	513-559-0900

Provider Business Practice Location Address
First Line	:	1061 DECKER DR
Second Line	:
City	:	MIAMISBURG
State	:	OH
Zip	:	45342-6415
Country	:	US
Telephone Number	:	231-492-4587
Fax Number	:

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

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	04/24/2014

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Directions to “ ALAN FARK MD” Practice Location

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