Provider Demographics
NPI:1902842768
Name:COLE, WILLIAM CLIFFORD II (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CLIFFORD
Last Name:COLE
Suffix:II
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 1:770 W HIGH ST STE 240
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-5906
Mailing Address - Country:US
Mailing Address - Phone:419-996-2686
Mailing Address - Fax:865-446-9726
Practice Address - Street 1:770 W HIGH ST STE 240
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801
Practice Address - Country:US
Practice Address - Phone:419-996-2686
Practice Address - Fax:419-996-2687
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29486207RC0200X, 207RP1001X
OH35133203207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3818916Medicaid
TN110192988OtherRR MEDICARE PIN
TN110192988OtherRR MEDICARE PIN
TN3717547Medicare PIN
TN103I290193Medicare PIN
TN3818916Medicaid