Provider Demographics
NPI:1174670657
Name:FANG, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:FANG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9002 N MERIDIAN ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5350
Mailing Address - Country:US
Mailing Address - Phone:317-819-4516
Mailing Address - Fax:317-819-0044
Practice Address - Street 1:5255 E STOP 11 RD
Practice Address - Street 2:SUITE 400
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-6341
Practice Address - Country:US
Practice Address - Phone:317-844-7059
Practice Address - Fax:317-819-0044
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2021-06-18
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Provider Licenses
StateLicense IDTaxonomies
IN01039524A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN040008970OtherMEDICARE RAILROAD
IN100338710Medicaid
IN040008970OtherMEDICARE RAILROAD
IN100338710Medicaid