Provider Demographics
NPI:1033265962
Name:DRAKE, MILES EDWARD (JR, MD)
Entity Type:Individual
Prefix:
First Name:MILES
Middle Name:EDWARD
Last Name:DRAKE
Suffix:
Gender:M
Credentials:JR, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E MAIN ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-5369
Mailing Address - Country:US
Mailing Address - Phone:614-265-8809
Mailing Address - Fax:614-233-9201
Practice Address - Street 1:500 E MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5369
Practice Address - Country:US
Practice Address - Phone:614-265-8809
Practice Address - Fax:614-233-9201
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH47457204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine