Provider Demographics
NPI:1982647582
Name:COLE, WINDY ELAINE (DPM)
Entity Type:Individual
Prefix:
First Name:WINDY
Middle Name:ELAINE
Last Name:COLE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 S WATER ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-4471
Mailing Address - Country:US
Mailing Address - Phone:330-285-3116
Mailing Address - Fax:330-673-4228
Practice Address - Street 1:1533 S WATER ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-4471
Practice Address - Country:US
Practice Address - Phone:330-285-3116
Practice Address - Fax:330-673-4228
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003245C213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2220715Medicaid
OH000000301088OtherANTHEMBCBS
OH2220715Medicaid
U84077Medicare UPIN
OH4776560001Medicare NSC