Healthcare Provider Details

I. General information

NPI: 1912900689
Provider Name (Legal Business Name): RAY EDWARD DRASGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 03/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 S MAIN ST STE 301
CROWN POINT IN
46307-3677
US

IV. Provider business mailing address

3975 WILLIAM RICHARDSON DR
SOUTH BEND IN
46628-9800
US

V. Phone/Fax

Practice location:
  • Phone: 219-661-1640
  • Fax: 219-661-8066
Mailing address:
  • Phone: 800-860-8100
  • Fax: 574-237-1341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number01031484A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: