Provider Demographics
NPI:1164696787
Name:BERNARD KOLE MD PC
Entity Type:Organization
Organization Name:BERNARD KOLE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-626-1700
Mailing Address - Street 1:6016 W MAPLE RD STE 700
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4411
Mailing Address - Country:US
Mailing Address - Phone:248-626-1700
Mailing Address - Fax:248-626-1710
Practice Address - Street 1:6016 W MAPLE RD STE 700
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4411
Practice Address - Country:US
Practice Address - Phone:248-626-1700
Practice Address - Fax:248-626-1710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBK0502612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0631193Medicare PIN
MIE49494Medicare UPIN