Provider Demographics
NPI:1003868191
Name:DRUZGAL, BYRON J
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:J
Last Name:DRUZGAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 EDGEWATER CT
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-2171
Mailing Address - Country:US
Mailing Address - Phone:717-387-2255
Mailing Address - Fax:717-387-2255
Practice Address - Street 1:606 EDGEWATER CT
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-2171
Practice Address - Country:US
Practice Address - Phone:616-842-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061444207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00150017OtherRAILROAD
MD451601000Medicaid
MD405812700Medicaid
MDP00150017OtherRAILROAD
MDI20939Medicare UPIN
MD613LMedicare ID - Type UnspecifiedMEDICARE GRP #
115826GZ5Medicare PIN
MD613LJ963Medicare PIN
MD405812700Medicaid