Individual
KEVIN COLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1105 SIXTH ST, TRAVERSE CITY, MI 49684-2349
(231) 935-7514
Mailing address
1105 SIXTH ST, TRAVERSE CITY, MI 49684-2349
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
5601007573
MI
Other
Enumeration date
04/28/2014
Last updated
11/05/2015
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