Provider Demographics
NPI:1912900689
Name:DRASGA, RAY EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:EDWARD
Last Name:DRASGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3975 WILLIAM RICHARDSON DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628-9800
Mailing Address - Country:US
Mailing Address - Phone:800-860-8100
Mailing Address - Fax:574-237-1341
Practice Address - Street 1:1205 S MAIN ST
Practice Address - Street 2:STE 301
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3677
Practice Address - Country:US
Practice Address - Phone:219-661-1640
Practice Address - Fax:219-661-8066
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2012-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01031484A207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100361750BMedicaid
INP00982059OtherRR MEDICARE
INP00982059OtherRR MEDICARE
IN100361750BMedicaid
E03879Medicare UPIN
IN4905250001Medicare NSC