Provider Demographics
NPI:1942260039
Name:FARA, EDWARD F (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:F
Last Name:FARA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1040 SIERRA DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7240
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:761 45TH AVE
Practice Address - Street 2:STE 108
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2893
Practice Address - Country:US
Practice Address - Phone:219-922-5416
Practice Address - Fax:219-922-3745
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2021-03-18
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Provider Licenses
StateLicense IDTaxonomies
IN01033200207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM147140052OtherMEDICARE PTAN
IN100361870Medicaid
IN499500 HMedicare PIN
E03920Medicare UPIN