MEDICARE: WILLIAM DRAKE

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1992174320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM DRAKE

Provider Business Mailing Address
First Line	:	645 GARRETT DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-2913
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1217 GRANDVIEW AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-3455
Country	:	US
Telephone Number	:	614-314-7119
Fax Number	:

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

Provider Enumeration Date	:	09/16/2015
Last Update Date	:	09/16/2015

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Directions to “ WILLIAM DRAKE ” Practice Location

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