Provider Demographics
NPI:1003252453
Name:MCEWEN, COLE (MD)
Entity Type:Individual
Prefix:
First Name:COLE
Middle Name:
Last Name:MCEWEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:KS
Mailing Address - Zip Code:67420-1605
Mailing Address - Country:US
Mailing Address - Phone:857-382-2667
Mailing Address - Fax:
Practice Address - Street 1:8919 PARALLEL PKWY STE 206
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1655
Practice Address - Country:US
Practice Address - Phone:913-334-6800
Practice Address - Fax:913-334-0875
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ55831208600000X
KS04-46162208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ379921Medicaid