David L Faulk, MD
Individual provider Active NPI Colon & Rectal Surgery Physician · Sandwich, IL
NPI 1760475271 · NPPES record last updated Jan 9, 2009
Key facts
- NPI
- 1760475271
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Colon & Rectal Surgery Physician 208C00000X
- License
- 036 049209 (IL)
- Practice address
- 1 E Countyline Rd
Sandwich, IL 60548-2178 - Phone
- (815) 786-2722
- Fax
- (815) 786-6840
- NPI assigned
- Aug 30, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036 049209 | IL | MD | Colon & Rectal Surgery Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Colon & Rectal Surgery Physician | 208C00000X | 036 049209 | IL | Yes |
Addresses
Primary practice location
1 E Countyline Rd
Sandwich, IL 60548-2178
Mailing address
1 E Countyline Rd
Sandwich, IL 60548-2178
Phone (815) 786-2722
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1921614 | Other | BC/BS | |
| 036049209 | Medicaid | IL |
Other providers in Sandwich, IL
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- Victor Robert Epperson
- Erik Englehart MD Family Medicine LLC
- Jenise Ervin
- James Joseph Fedinec
- First Impressions by Lerohl & Landers
- Latehesha Fitch
- Katie Michelle Fitzgerald
- Kara Flynn
All providers in Sandwich, IL · Colon & Rectal Surgery Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 9, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.