Individual
DONALD FAHLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
253 SAGAMORE PKWY W, WEST LAFAYETTE, IN 47906-1501
(765) 448-8000
(765) 448-7606
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01067769A
IN
208000000X
Pediatrics Physician
57.013903
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000670768
ANTHEM PROVIDER NUMBER
IN
05
—
200980950
—
IN
Enumeration date
06/26/2008
Last updated
02/02/2021
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