Provider Demographics
NPI:1821054750
Name:COLE DERMATOLOGY
Entity Type:Organization
Organization Name:COLE DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:507-645-2212
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-0099
Mailing Address - Country:US
Mailing Address - Phone:507-645-2212
Mailing Address - Fax:507-645-0616
Practice Address - Street 1:710 DIVISION ST S
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2468
Practice Address - Country:US
Practice Address - Phone:507-645-2212
Practice Address - Fax:507-645-0616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2871806207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN112904OtherGROUP HEALTH
MN24T70COOtherBLUE CROSS
MND367OtherUCARE
MN989381012966OtherPREFERRED ONE COMM
MN989381012966OtherPREFERRED ONE COMM