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Organization
MICHIANA SPINE, SPORTS & OCCUPATIONAL REHAB, PC
Active
Organization
MICHIANA SPINE, SPORTS & OCCUPATIONAL REHAB, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN GENE DREW M.D. (PRESIDENT)
(574) 252-4150
Entity
Organization
Contact information
Practice address
3740 EDISON LAKES PKWY, MISHAWAKA, IN 46545-3474
(574) 252-4150
(574) 252-4159
Mailing address
3740 EDISON LAKES PKWY, MISHAWAKA, IN 46545-3474
(574) 252-4150
(574) 252-4159
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
01042863
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
129646400
DEPT OF LABORACS
—
05
—
200216220A
—
IN
01
—
25-0A110370
BCBSMI
MI
01
—
CI5205
RAILROAD MEDICARE
—
Enumeration date
11/29/2006
Last updated
11/03/2022
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