Provider Demographics
NPI:1457497307
Name:MERCHO, FAROUK E (MD)
Entity Type:Individual
Prefix:
First Name:FAROUK
Middle Name:E
Last Name:MERCHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FRANK
Other - Middle Name:E
Other - Last Name:MERCHO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3900 ST FRANCIS WAY
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4923
Mailing Address - Country:US
Mailing Address - Phone:765-446-4819
Mailing Address - Fax:765-446-4859
Practice Address - Street 1:1701 S CREASY LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4972
Practice Address - Country:US
Practice Address - Phone:765-446-4819
Practice Address - Fax:765-446-4859
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031856A2085R0202X
OH35.0884032085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000379915OtherBCBS
INP00817909OtherRR MEDICARE
IN000000653260OtherANTHEM BCBS
IN100320650Medicaid
OH2863414Medicaid
OH2863414Medicaid
IN100320650Medicaid
IN232250Medicare PIN
IN000000653260OtherANTHEM BCBS
OHME4247641Medicare PIN