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General NPI Number Information
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NPI Number | 1013114552
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Entity Type | Organization
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Legal Business Name | GEORGE E. DRAKE, M.D., P.C.
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1 S 5TH ST
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City | NILES
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State | MI
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Zip | 49120-2710
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Country | US
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Telephone | 269-687-9607
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Fax |
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Provider Business Mailing Address
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Address Line | 732 S 11TH ST SUITE 100 #242
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City | NILES
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State | MI
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Zip | 49120-3368
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Country | US
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Telephone | 269-687-9607
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. GEORGE ERVING DRAKE
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Credential | M.D.
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Telephone | 269-687-9607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 4301034140
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License Number State | MI
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