Individual
DR. WILLIAM NORVAL FARABAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1815 E IRELAND RD, SOUTH BEND, IN 46614-2845
(574) 647-1700
(574) 647-7572
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01059548A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000334831
BCBS BMG IRELAND RD
IN
05
—
200491800
—
IN
01
—
P00142860
RR MEDICARE
IN
Enumeration date
10/11/2005
Last updated
04/01/2021
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