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General NPI Number Information
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NPI Number | 1821054750
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Entity Type | Organization
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Legal Business Name | COLE DERMATOLOGY
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 710 DIVISION ST S
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City | NORTHFIELD
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State | MN
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Zip | 55057-2468
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Country | US
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Telephone | 507-645-2212
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Fax | 507-645-0616
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Provider Business Mailing Address
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Address Line | PO BOX 99
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City | NORTHFIELD
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State | MN
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Zip | 55057-0099
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Country | US
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Telephone | 507-645-2212
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Fax | 507-645-0616
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Authorized Official
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Title or Position | PRESIDENT
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Name | HEIDI COLE
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Credential | MD
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Telephone | 507-645-2212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 2871806
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License Number State | MN
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