Provider Demographics
NPI:1871862128
Name:JEFFREY G. DRAESEL MD PA
Entity Type:Organization
Organization Name:JEFFREY G. DRAESEL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAESEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-864-1373
Mailing Address - Street 1:1108 KANE CONCOURSE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2068
Mailing Address - Country:US
Mailing Address - Phone:305-864-1373
Mailing Address - Fax:305-868-3124
Practice Address - Street 1:1108 KANE CONCOURSE
Practice Address - Street 2:SUITE 300
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2068
Practice Address - Country:US
Practice Address - Phone:305-864-1373
Practice Address - Fax:305-868-3124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27367207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D27240Medicare UPIN