Provider Demographics
NPI:1639223605
Name:DREW, GEORGE R (DO)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:R
Last Name:DREW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5215 HOLY CROSS PKWY
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1469
Mailing Address - Country:US
Mailing Address - Phone:574-335-5000
Mailing Address - Fax:574-273-1137
Practice Address - Street 1:5215 HOLY CROSS PKWY
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1469
Practice Address - Country:US
Practice Address - Phone:574-335-5000
Practice Address - Fax:574-273-1137
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009164207P00000X
IN02003439207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200922330Medicaid
IN000000593395OtherANTHEM
INP00671030OtherRR MEDICARE
MI930005546OtherRAILROAD MEDICARE
MID16094020Medicare PIN
INP00671030OtherRR MEDICARE
IN176490VMedicare PIN