Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 5101007287 | MI |
NPI | 1457469330 |
---|---|
Provider Name | Dr. Eric N. Coffman |
First Address | Livonia, MI 48150-4145 |
Second Address | Livonia, MI 48150-4145 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 05/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4198968 | (05) | MI |
E40000 | (02) | MI |