MEDICARE: TAMIKA COLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	4703092240	MI

General Provider Information

NPI Number	:	1518311257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMIKA COLE

Provider Business Mailing Address
First Line	:	4060 FRANKLIN PARK DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-1934
Country	:	US
Telephone Number	:	313-721-5509
Fax Number	:

Provider Business Practice Location Address
First Line	:	4060 FRANKLIN PARK DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-1934
Country	:	US
Telephone Number	:	313-721-5509
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2016
Last Update Date	:	04/19/2016

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Directions to “ TAMIKA COLE ” Practice Location

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