Provider Demographics
NPI:1467583542
Name:DRAESEL, JEFFREY GLEN (MD PA)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:GLEN
Last Name:DRAESEL
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16400 NE 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4115
Mailing Address - Country:US
Mailing Address - Phone:305-864-1373
Mailing Address - Fax:305-868-3124
Practice Address - Street 1:1108 KANE CONCOURSE
Practice Address - Street 2:300
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2068
Practice Address - Country:US
Practice Address - Phone:305-864-1373
Practice Address - Fax:305-868-3124
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27367207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD27240Medicare UPIN