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NPI Code Detail

MEDICARE: MR. DONALD CHARLES DRAKE III

MEDICARE: MR. DONALD CHARLES DRAKE III
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1841175197
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DONALD CHARLES DRAKE III
Provider Business Mailing Address
First Line : 2702 GLYNN CT
Second Line :
City : DETROIT
State : MI
Zip : 48206-1618
Country : US
Telephone Number : 248-875-6284
Fax Number :
Provider Business Practice Location Address
First Line : 2146 MOELLER AVE
Second Line :
City : YPSILANTI
State : MI
Zip : 48198-9237
Country : US
Telephone Number : 734-450-7960
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2025
Last Update Date : 08/07/2025

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