Provider Demographics
NPI:1538782933
Name:COLE, MARCEL
Entity type:Individual
Prefix:
First Name:MARCEL
Middle Name:
Last Name:COLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26263 GIBRALTAR RD
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:MI
Mailing Address - Zip Code:48134-1579
Mailing Address - Country:US
Mailing Address - Phone:734-379-0736
Mailing Address - Fax:734-379-3998
Practice Address - Street 1:26263 GIBRALTAR RD
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:MI
Practice Address - Zip Code:48134-1579
Practice Address - Country:US
Practice Address - Phone:734-379-0736
Practice Address - Fax:734-379-3998
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI802447082251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI802447082OtherIN HOME CARE SERVICES