Provider Demographics
NPI:1205984234
Name:DRAKE, ROBERT GRANT JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GRANT
Last Name:DRAKE
Suffix:JR
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 1:623 WEST HURON ST.
Mailing Address - Street 2:OFFICE 2C
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6712
Mailing Address - Country:US
Mailing Address - Phone:734-668-0099
Mailing Address - Fax:
Practice Address - Street 1:623 WEST HURON ST.
Practice Address - Street 2:OFFICE 2C
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6712
Practice Address - Country:US
Practice Address - Phone:734-668-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010393462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA73225Medicare UPIN