Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 4301060101 | MI |
N | 207VG0400X | Gynecologist | LC060101 | MI |
NPI | 1033150032 |
---|---|
Provider Name | Lanetta Coleman |
First Address | Detroit, MI 48235 |
Second Address | Detroit, MI 48235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 02/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104536439 | (05) | MI |
G33856 | (02) |