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Individual

ALAN FARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1061 DECKER DR, MIAMISBURG, OH 45342-6415
(231) 492-4587
Mailing address
3802 PAXTON AVE STE 1, CINCINNATI, OH 45209-2399
(513) 559-9700
(513) 559-0900

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35.093391
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
104462999
MI
05
200997410
IN
05
3110869
OH
01
AF048957
BLUE SHIELD PIN
MI
01
MI430448957
BLUE CROSS PIN
MI
Enumeration date
02/19/2007
Last updated
04/24/2014
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