Provider Demographics
NPI:1629152152
Name:DRAKE, LUCAS MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:MATTHEW
Last Name:DRAKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8051 SOUTH EMERSON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8632
Mailing Address - Country:US
Mailing Address - Phone:317-865-2955
Mailing Address - Fax:317-865-2944
Practice Address - Street 1:8051 SOUTH EMERSON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8632
Practice Address - Country:US
Practice Address - Phone:317-865-2955
Practice Address - Fax:317-865-2944
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01069652A207RG0100X, 207RG0100X
SC25-28061207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201023420Medicaid
INM400049541OtherMEDICARE
IN201023420Medicaid