Provider Demographics
NPI:1033979174
Name:FARRALES, ELIJAH RAYN (MD)
Entity type:Individual
Prefix:
First Name:ELIJAH
Middle Name:RAYN
Last Name:FARRALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 W 16TH ST STE 4300
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2394
Mailing Address - Country:US
Mailing Address - Phone:317-274-8157
Mailing Address - Fax:
Practice Address - Street 1:3595 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3440
Practice Address - Country:US
Practice Address - Phone:614-566-5456
Practice Address - Fax:614-566-6902
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program