MEDICARE: COLES HEALTHCARE SERVICES INC

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	207Q00000X	Family Medicine Physician	PA9104805	FL

General Provider Information

NPI Number	:	1306210877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLES HEALTHCARE SERVICES INC

Provider Business Mailing Address
First Line	:	3898 W COMMERCIAL BLVD
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33309-3326
Country	:	US
Telephone Number	:	754-444-8826
Fax Number	:	954-856-2921

Provider Business Practice Location Address
First Line	:	3898 W COMMERCIAL BLVD
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33309-3326
Country	:	US
Telephone Number	:	754-444-8826
Fax Number	:	954-856-2921

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DONALD COLES
Credential	:	PA-C
Telephone Number	:	954-593-5524

Provider Enumeration Date	:	11/21/2015
Last Update Date	:	11/21/2015

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Directions to “COLES HEALTHCARE SERVICES INC ” Practice Location

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