Healthcare Provider Details

I. General information

NPI: 1285604355
Provider Name (Legal Business Name): DOUGLAS DREHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 MICHAEL DR STE I
CHESTERTON IN
46304-2695
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 219-395-2142
  • Fax: 219-929-4292
Mailing address:
  • Phone: 317-528-4800
  • Fax: 178-651-4793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01053892A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: