Provider Demographics
NPI:1548015738
Name:COLE, ANTOINE ROYCE
Entity type:Individual
Prefix:
First Name:ANTOINE
Middle Name:ROYCE
Last Name:COLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4469 OXBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-5358
Mailing Address - Country:US
Mailing Address - Phone:216-645-4929
Mailing Address - Fax:
Practice Address - Street 1:4469 OXBRIDGE LN
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-5358
Practice Address - Country:US
Practice Address - Phone:216-645-4929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRT603035172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver