Provider Demographics
NPI:1588078471
Name:COLE, TIM (LMT, NCTMB)
Entity type:Individual
Prefix:MR
First Name:TIM
Middle Name:
Last Name:COLE
Suffix:
Gender:M
Credentials:LMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7130 ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4102
Mailing Address - Country:US
Mailing Address - Phone:763-477-1029
Mailing Address - Fax:
Practice Address - Street 1:11300 MINNETONKA MILLS RD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-5100
Practice Address - Country:US
Practice Address - Phone:952-933-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor