Basic Information
| Provider Information | |||||||||
| NPI: | 1265480164 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FABER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1011 OLD HIGHWAY 60 | ||||||||
| Address2: | |||||||||
| City: | HARDINSBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 401432519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707567000 | ||||||||
| FaxNumber: | 2707566510 | ||||||||
| Practice Location | |||||||||
| Address1: | 607 OLD HIGHWAY 60 | ||||||||
| Address2: | |||||||||
| City: | HARDINSBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2705802256 | ||||||||
| FaxNumber: | 2705802251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 12/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 32091 | KY | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 64101538 | 05 | KY | MEDICAID | P01065307 | 01 | KY | MEDICARE RR | OTHER |