Healthcare Provider Details

I. General information

NPI: 1619137072
Provider Name (Legal Business Name): PAUL MICHAEL DRAYNA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 FRANCE AVE S STE 115
EDINA MN
55435-2283
US

IV. Provider business mailing address

6525 FRANCE AVE S STE 115
EDINA MN
55435-2283
US

V. Phone/Fax

Practice location:
  • Phone: 952-345-8200
  • Fax: 952-345-8207
Mailing address:
  • Phone: 952-345-8200
  • Fax: 952-345-8207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number25501
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25501
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number58924
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: