Provider Demographics
NPI:1164598835
Name:COFFIN, SUZANNE C (PA)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:C
Last Name:COFFIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 PARK FOREST DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7331
Mailing Address - Country:US
Mailing Address - Phone:231-935-9060
Mailing Address - Fax:231-935-9045
Practice Address - Street 1:4100 PARK FOREST DR
Practice Address - Street 2:SUITE 208
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7331
Practice Address - Country:US
Practice Address - Phone:231-935-9060
Practice Address - Fax:231-935-9045
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003399363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOB81010OtherBCBSM
MI0M83990Medicare ID - Type Unspecified