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General NPI Number Information
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NPI Number | 1245124494
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Entity Type | Individual
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Provider Name | COLE DAVID KAMENDAT
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Gender | Male
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Dates
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Enumeration Date | 06/04/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 3111 ELECTRIC AVE
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City | PORT HURON
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State | MI
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Zip | 48060-8127
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Country | US
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Telephone | 810-966-2576
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Fax |
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Provider Business Mailing Address
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Address Line | 4792 WESTWOOD DR
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City | CLYDE
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State | MI
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Zip | 48049-4560
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Country | US
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Telephone | 810-887-1545
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Fax | 810-887-1545
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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