Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 4301049311 | MI |
NPI | 1124141650 |
---|---|
Provider Name | Daniel Hayden Drake |
First Address | Traverse City, MI 49685-8201 |
Second Address | Traverse City, MI 49685-8201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2007 |
Last Update Date | 25/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2974915 | (05) | MI |
E49442 | (02) | MI |