Dr Eleazar Domingo Fariscal, DO, DPT is a medicare enrolled "Internal Medicine" provider in Fort Wayne, Indiana. His current practice location is
2200 Randallia Dr, Fort Wayne, Indiana. You can reach out to his office (for appointments etc.) via phone at
(260) 373-4000.
Dr Eleazar Domingo Fariscal is licensed to practice in Indiana (license number 11023156A) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1851619993.
Healthcare Provider's Profile
Full Name | Dr Eleazar Domingo Fariscal |
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Gender | Male |
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Speciality | Internal Medicine |
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Location | 2200 Randallia Dr, Fort Wayne, Indiana |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1851619993
- Provider Enumeration Date: 05/13/2010
- Last Update Date: 07/22/2023
Medicare PECOS Information:
- PECOS PAC ID: 6709917800
- Enrollment ID: I20230626002392
Medical Identifiers
Medical identifiers for Dr Eleazar Domingo Fariscal such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1851619993 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
225100000X | Physical Therapist | (* (Not Available)) | Secondary |
390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Secondary |
207R00000X | Internal Medicine | 11023156A (Indiana) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Eleazar Domingo Fariscal is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Dr Eleazar Domingo Fariscal, DO, DPT 6912 Covington Ct, West Bloomfield, MI 48322-2962 Ph: (248) 205-0575 | Dr Eleazar Domingo Fariscal, DO, DPT 2200 Randallia Dr, Fort Wayne, IN 46805-4638 Ph: (260) 373-4000 |
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