Provider Demographics
NPI:1912508425
Name:MACKE, COLE EDWARD (DO)
Entity Type:Individual
Prefix:MR
First Name:COLE
Middle Name:EDWARD
Last Name:MACKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4207 KITSAP WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-2447
Mailing Address - Country:US
Mailing Address - Phone:360-415-1080
Mailing Address - Fax:360-415-1099
Practice Address - Street 1:4207 KITSAP WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-2447
Practice Address - Country:US
Practice Address - Phone:360-415-1080
Practice Address - Fax:360-415-1099
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOL61290726390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program