MEDICARE: TERRANCE JOSEPH DRAKE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	01036941	IN

General Provider Information

NPI Number	:	1750472049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRANCE JOSEPH DRAKE M.D.

Provider Business Mailing Address
First Line	:	8003 CASTLEWAY DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-1946
Country	:	US
Telephone Number	:	317-576-1335
Fax Number	:	317-576-1339

Provider Business Practice Location Address
First Line	:	8003 CASTLEWAY DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-1946
Country	:	US
Telephone Number	:	317-576-1335
Fax Number	:	317-576-1339

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	08/18/2007

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