Healthcare Provider Details

I. General information

NPI: 1205404639
Provider Name (Legal Business Name): RENEE MARY COLE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2021
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6777 W MAPLE RD
WEST BLOOMFIELD MI
48322-3013
US

IV. Provider business mailing address

1 FORD PL STE 3A
DETROIT MI
48202-3450
US

V. Phone/Fax

Practice location:
  • Phone: 248-325-1000
  • Fax: 313-876-1305
Mailing address:
  • Phone: 800-999-5829
  • Fax: 313-876-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number5101029425
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: