Healthcare Provider Details

I. General information

NPI: 1174997522
Provider Name (Legal Business Name): MR. JOSEPH GLENN DRAPALIK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2015
Last Update Date: 03/15/2020
Certification Date: 03/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST SUITE 3027A
DAYTON OH
45409-2722
US

IV. Provider business mailing address

330 W 1ST ST APT 1006
DAYTON OH
45402-3062
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-6173
  • Fax:
Mailing address:
  • Phone: 513-582-8225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCOA.18571-NA
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: