Individual
AUDREY DEEKEN DRAISEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
303 E CHICAGO AVE # 3140W127, CHICAGO, IL 60611-4296
(312) 503-8144
Mailing address
680 N LAKE SHORE DR, CHICAGO, IL 60611-4546
(312) 695-6868
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
036144258
IL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
X
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710305560
—
IL
Enumeration date
03/30/2014
Last updated
04/16/2018
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