Individual
COLE BLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(571) 244-8833
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125078289
IL
207R00000X
Internal Medicine Physician
Primary
5101027974
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/23/2021
Last updated
03/21/2024
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