Provider Demographics
NPI:1548851553
Name:VANCURA, COLE WILLIAM (BA)
Entity type:Individual
Prefix:
First Name:COLE
Middle Name:WILLIAM
Last Name:VANCURA
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 GRIFFIN RD
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-9251
Mailing Address - Country:US
Mailing Address - Phone:989-345-5571
Mailing Address - Fax:
Practice Address - Street 1:511 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-9251
Practice Address - Country:US
Practice Address - Phone:989-345-5571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator