Provider Demographics
NPI:1770511719
Name:DRAKE, CASSIUS M (MD)
Entity Type:Individual
Prefix:DR
First Name:CASSIUS
Middle Name:M
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 1:30600 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-2305
Mailing Address - Country:US
Mailing Address - Phone:248-990-3674
Mailing Address - Fax:
Practice Address - Street 1:30600 FOREST DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MI
Practice Address - Zip Code:48025-2305
Practice Address - Country:US
Practice Address - Phone:248-990-3674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI069972207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4810401Medicaid
MI4842209Medicaid
MICD069972OtherBC/BS
MI4842209Medicaid
MI4810401Medicaid