Southfield Neurological Assoc PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

BK027608 Issued in MI

Legal business name

SOUTHFIELD NEUROLOGICAL ASSOC PC

Practice address

22250 Providence Dr
Suite 402
Southfield, MI 48075-4825

Phone

(248) 559-3150

Fax

(248) 559-8218

NPI assigned

May 24, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Bruce H Kole, MDNPI 1437195013

Title

President

Phone

(248) 559-3150

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bruce H Kole, MD

  • Neurology Physician
  • Southfield, MI
  • NPI 1437195013
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276819200000",
    "number": "1770794737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22250 PROVIDENCE DR",
            "address_2": "SUITE 402",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754825",
            "telephone_number": "248-559-3150",
            "fax_number": "248-559-8218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22250 PROVIDENCE DR",
            "address_2": "SUITE 402",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754825",
            "telephone_number": "248-559-3150",
            "fax_number": "248-559-8218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHFIELD NEUROLOGICAL ASSOC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2010-06-18",
        "status": "A",
        "authorized_official_last_name": "KOLE",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-559-3150",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MI",
            "license": "BK027608",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1059871",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Southfield, MI
• Providers in Southfield, MI by specialty
• Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.