Provider Demographics
NPI:1184601080
Name:DRAKE, DAVID F (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:F
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 1:4380 MALSBARY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5644
Mailing Address - Country:US
Mailing Address - Phone:513-366-4488
Mailing Address - Fax:513-366-4480
Practice Address - Street 1:8000 5 MILE RD
Practice Address - Street 2:SUITE 310
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-2163
Practice Address - Country:US
Practice Address - Phone:513-232-0120
Practice Address - Fax:513-232-8483
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35031757207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0262540Medicaid
0641478OtherAETNA
OH283794OtherAMERIGROUP MEDICAID OH
31757-06OtherHUMANA
KY64866254Medicaid
25-20413OtherUNITED
OH311438871060OtherCARESOURCE MEDICAID OH
OH000000215208OtherANTHEM
0641478OtherAETNA
OH4144482Medicare PIN