Individual
EMMANUEL FAVILA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
97 E HALT DR, TERRE HAUTE, IN 47802-4285
(812) 238-2100
(812) 232-7772
Mailing address
97 E HALT DR, TERRE HAUTE, IN 47802-4285
(812) 238-2100
(812) 232-7772
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
01039992
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000092869
ANTHEM BLUE CROSS AND BLUE SHIELD
IN
05
—
100326580
—
IN
Enumeration date
04/27/2006
Last updated
05/13/2010
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