Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 4301074886 | MI |
N | 207PE0004X | Emergency Medical Services | 4301074886 | MI |
NPI | 1124048145 |
---|---|
Provider Name | Dr. Pamela N. Coffey |
First Address | Brecksville, OH 44141-3214 |
Second Address | Lansing, MI 48912-1811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 26/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0102512592 | BLUE CROSS BLUE SHIELD (01) | MI |
0B51090 | BLUE SHIELD (01) | MI |
200000001792 | PHP (01) | MI |
4723816 | (05) | MI |
4866416 | (05) | MI |
H76585 | (02) | MI |