MEDICARE: MARK J DROEGE EDUCATOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator

General Provider Information

NPI Number	:	1104633494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK J DROEGE EDUCATOR

Provider Business Mailing Address
First Line	:	2627 CARLYLE AVE
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62221-5882
Country	:	US
Telephone Number	:	618-236-9983
Fax Number	:

Provider Business Practice Location Address
First Line	:	2627 CARLYLE AVE
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62221-5882
Country	:	US
Telephone Number	:	618-236-9983
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2024
Last Update Date	:	12/11/2024

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