Provider Demographics
NPI:1972787067
Name:COLE, SHAWN M (MD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:M
Last Name:COLE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10850 E TRAVERSE HWY STE 1155
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-1363
Mailing Address - Country:US
Mailing Address - Phone:844-235-5963
Mailing Address - Fax:
Practice Address - Street 1:10850 E TRAVERSE HWY STE 1155
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-1363
Practice Address - Country:US
Practice Address - Phone:231-268-0013
Practice Address - Fax:469-319-9379
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT047065207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine