Provider Demographics
NPI:1124001490
Name:COLE, MICHAEL K (DO)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:K
Last Name:COLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4939
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74159-0939
Mailing Address - Country:US
Mailing Address - Phone:918-743-8943
Mailing Address - Fax:918-388-1242
Practice Address - Street 1:4111 S DARLINGTON AVE
Practice Address - Street 2:STE 700
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6348
Practice Address - Country:US
Practice Address - Phone:918-743-8943
Practice Address - Fax:918-388-1242
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK39382085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100160290AMedicaid
OK300133125OtherRAILROAD MEDICARE
OK248224703OtherMEDICARE
OK300133517OtherRAILROAD MEDICARE
OK248224703OtherMEDICARE
OK300133517OtherRAILROAD MEDICARE