Provider Demographics
NPI:1861444085
Name:COLE, STEPHANIE MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:COLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6005 MONCLOVA RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1864
Mailing Address - Country:US
Mailing Address - Phone:419-578-7555
Mailing Address - Fax:419-539-6336
Practice Address - Street 1:6005 MONCLOVA RD
Practice Address - Street 2:SUITE 320
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1864
Practice Address - Country:US
Practice Address - Phone:419-578-7555
Practice Address - Fax:419-539-6336
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85383207Y00000X
NC2008-02091207Y00000X
OH35.120125207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0089152Medicaid
OHH233120Medicare PIN