Provider Demographics
NPI:1407991649
Name:KOLE, BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:
Last Name:KOLE
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 1:6016 W MAPLE RD
Mailing Address - Street 2:#700
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
Practice Address - Street 2:#700
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010502612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE49494Medicare UPIN
MI0631193Medicare ID - Type Unspecified