Healthcare Provider Details

I. General information

NPI: 1245124494
Provider Name (Legal Business Name): COLE DAVID KAMENDAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 ELECTRIC AVE
PORT HURON MI
48060-8127
US

IV. Provider business mailing address

4792 WESTWOOD DR
CLYDE MI
48049-4560
US

V. Phone/Fax

Practice location:
  • Phone: 810-966-2576
  • Fax:
Mailing address:
  • Phone: 810-887-1545
  • Fax: 810-887-1545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: