Provider Demographics
NPI:1437195013
Name:KOLE, BRUCE H (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:H
Last Name:KOLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:22250 PROVIDENCE DR
Mailing Address - Street 2:SUITE 402
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075
Mailing Address - Country:US
Mailing Address - Phone:248-559-3150
Mailing Address - Fax:248-559-8218
Practice Address - Street 1:22250 PROVIDENCE DR
Practice Address - Street 2:SUITE 402
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4825
Practice Address - Country:US
Practice Address - Phone:248-559-3150
Practice Address - Fax:248-559-8218
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBK0276082084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1059871Medicaid
B44824Medicare UPIN
0638957Medicare ID - Type Unspecified