Provider Demographics
NPI:1689662710
Name:DRAKE, MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:DRAKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 EAST CARPENTER STREET
Mailing Address - Street 2:ROOM 2K64
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62769-0001
Mailing Address - Country:US
Mailing Address - Phone:217-525-5643
Mailing Address - Fax:217-544-2521
Practice Address - Street 1:800 EAST CARPENTER STREET
Practice Address - Street 2:ROOM 2K64
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62769-0001
Practice Address - Country:US
Practice Address - Phone:217-525-5643
Practice Address - Fax:217-544-2521
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0036098003207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL031806OtherGROUP-CHAMPUS/TRICARE
IL085972OtherHEALTH ALLIANCE NUMBER
IL104409OtherHEALTHLINK GROUP #
IL036098003Medicaid
IL387862OtherHEALTHLINK UPIN NUMBER
IL08415040OtherBLUE CROSS BLUE SHIELD
IL32490OtherPERSONAL CARE
ILL67085Medicare ID - Type UnspecifiedMEDICARE PART B
IL1285290Medicare ID - Type UnspecifiedMEDICARE UMWA#
ILCF2131Medicare ID - Type UnspecifiedMEDICARE RR GROUP NUMBER
ILG84149Medicare UPIN
IL779520Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
IL036098003Medicaid