Healthcare Provider Details

I. General information

NPI: 1871021147
Provider Name (Legal Business Name): DANIEL A DRAKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 07/21/2022
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4611 CAMPUS RIDGE DR
MIDLAND MI
48640-9533
US

IV. Provider business mailing address

75 BUSCHLEN RD
BAD AXE MI
48413-9177
US

V. Phone/Fax

Practice location:
  • Phone: 989-839-3500
  • Fax: 989-839-3344
Mailing address:
  • Phone: 989-623-9300
  • Fax: 989-269-0243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301505192
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: