Organization
MAINE FUNCTIONAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY DRAKE (OFFICE MANAGER)
(207) 941-0080
Entity
Organization
Contact information
Practice address
33 PENN PLZ STE A, BANGOR, ME 04401-3619
(207) 941-0080
(207) 941-0093
Mailing address
33 PENN PLZ STE A, BANGOR, ME 04401-3619
(207) 941-0080
(207) 941-0093
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053336206
NPI
ME
Enumeration date
01/29/2019
Last updated
01/29/2019
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