Provider Demographics
NPI:1306854252
Name:DRAKE, MELISSA MARTENS (DO)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MARTENS
Last Name:DRAKE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 634087
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-4087
Mailing Address - Country:US
Mailing Address - Phone:800-540-8739
Mailing Address - Fax:616-975-9827
Practice Address - Street 1:2926 S CEDAR HOLLOW DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8154
Practice Address - Country:US
Practice Address - Phone:713-456-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0739207P00000X
MI5101015424207PE0004X
IL036124379207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
I16739Medicare UPIN