Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CP0003282 | MI |
NPI | 1487248662 |
---|---|
Provider Name | Mr. Rodney John Coleman |
First Address | Flint, MI 48504-4497 |
Second Address | Flint, MI 48504-4497 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2021 |
Last Update Date | 27/02/2021 |