Healthcare Provider Details

I. General information

NPI: 1780989137
Provider Name (Legal Business Name): SEAN MICHAEL DRAHUSCHAK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2011
Last Update Date: 04/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # E31
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

15410 W SPRAGUE RD APT F70
MIDDLEBURG HEIGHTS OH
44130-6957
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-1278
  • Fax:
Mailing address:
  • Phone: 517-673-0932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCOA.12094-NA
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: