Provider Demographics
NPI:1548770274
Name:MIKEL, DREW ALLEN
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:ALLEN
Last Name:MIKEL
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 1:28694 COULTER ST
Mailing Address - Street 2:
Mailing Address - City:EDWARDSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49112-9639
Mailing Address - Country:US
Mailing Address - Phone:574-350-9396
Mailing Address - Fax:
Practice Address - Street 1:28694 COULTER ST
Practice Address - Street 2:
Practice Address - City:EDWARDSBURG
Practice Address - State:MI
Practice Address - Zip Code:49112-9639
Practice Address - Country:US
Practice Address - Phone:574-350-9396
Practice Address - Fax:574-350-9396
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty