Provider Demographics
NPI:1114946589
Name:COFFEY, ARTHUR CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:CHARLES
Last Name:COFFEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 WELLS ST APT 110
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-1452
Mailing Address - Country:US
Mailing Address - Phone:317-507-0927
Mailing Address - Fax:
Practice Address - Street 1:425 WELLS ST APT 110
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-1452
Practice Address - Country:US
Practice Address - Phone:317-507-0927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI61997-20204F00000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200217230Medicaid
INM22404016Medicare PIN
IN257700BMedicare PIN
INM400071957Medicare PIN
INM400056761Medicare PIN
INP00632721Medicare PIN
INP01134253Medicare PIN