Basic Information
| Provider Information | |||||||||
| NPI: | 1003868191 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DRUZGAL | ||||||||
| FirstName: | BYRON | ||||||||
| MiddleName: | J | ||||||||
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| Mailing Information | |||||||||
| Address1: | 606 EDGEWATER CT | ||||||||
| Address2: | |||||||||
| City: | SPRING LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494562171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173872255 | ||||||||
| FaxNumber: | 7173872255 | ||||||||
| Practice Location | |||||||||
| Address1: | 606 EDGEWATER CT | ||||||||
| Address2: | |||||||||
| City: | SPRING LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494562171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6168423600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 03/03/2011 | ||||||||
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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 | 207P00000X | D0061444 | MD | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00150017 | 01 | MD | RAILROAD | OTHER | 451601000 | 05 | MD | MEDICAID | 405812700 | 05 | MD | MEDICAID |