Provider Demographics
NPI:1922238666
Name:COLE, STEPHANIE JOY (DO)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JOY
Last Name:COLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:JOY
Other - Last Name:INGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1 WILLIAM CARLS DR STE G131
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-2201
Mailing Address - Country:US
Mailing Address - Phone:248-242-7330
Mailing Address - Fax:248-242-5616
Practice Address - Street 1:1 WILLIAM CARLS DR STE G131
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-2201
Practice Address - Country:US
Practice Address - Phone:248-242-7330
Practice Address - Fax:248-242-5616
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018273208600000X
OH34-011401208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery