Healthcare Provider Details

I. General information

NPI: 1326042045
Provider Name (Legal Business Name): MICHAEL J DRAGER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 06/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 W IRONWOOD DR STE 301
COEUR D ALENE ID
83814-4903
US

IV. Provider business mailing address

850 W IRONWOOD DR STE 301
COEUR D ALENE ID
83814-4903
US

V. Phone/Fax

Practice location:
  • Phone: 208-667-9762
  • Fax: 208-765-1041
Mailing address:
  • Phone: 208-667-9762
  • Fax: 208-765-1041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberP134
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: