Provider Demographics
NPI:1407894454
Name:MIKA K. COLE, MD, PA
Entity Type:Organization
Organization Name:MIKA K. COLE, MD, PA
Other - Org Name:ADULT AND PEDIATRI ALLERGY ASHTMA AND IMMUNOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIKA
Authorized Official - Middle Name:KAMADA
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-930-4555
Mailing Address - Street 1:8001 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2628
Mailing Address - Country:US
Mailing Address - Phone:210-930-4555
Mailing Address - Fax:210-930-0893
Practice Address - Street 1:8001 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5713
Practice Address - Country:US
Practice Address - Phone:210-930-4555
Practice Address - Fax:210-930-0893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8701207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172010401Medicaid
TX172010401Medicaid
TX00124XMedicare ID - Type Unspecified