Basic Information
| Provider Information | |||||||||
| NPI: | 1548293707 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DREWS | ||||||||
| FirstName: | FREDDY | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5655 HUDSON DRIVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | HUDSON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442364451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306553800 | ||||||||
| FaxNumber: | 3306553828 | ||||||||
| Practice Location | |||||||||
| Address1: | 5655 HUDSON DRIVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | HUDSON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442364451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306553800 | ||||||||
| FaxNumber: | 3306553828 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 10/25/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 35-079547 | OH | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 35.079547 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 000000221244 | 01 | OH | UNISON | OTHER | 0304914 | 01 | OH | BCMH | OTHER | P00412318 | 01 | OH | RAILROAD MEDICARE | OTHER | 000000503573 | 01 | OH | ANTHEM | OTHER | 363492 | 01 | OH | WELLCARE | OTHER | 7273270 | 01 | OH | AETNA | OTHER | 2268586 | 05 | OH | MEDICAID | 732391 | 01 | OH | BUCKEYE | OTHER |