Provider Demographics
NPI:1326214339
Name:DANIEL C COFFEY MD
Entity Type:Organization
Organization Name:DANIEL C COFFEY MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:527-372-0500
Mailing Address - Street 1:737 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-5160
Mailing Address - Country:US
Mailing Address - Phone:517-372-0500
Mailing Address - Fax:517-482-3220
Practice Address - Street 1:737 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-5160
Practice Address - Country:US
Practice Address - Phone:517-372-0500
Practice Address - Fax:517-482-3220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074515208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4748940Medicaid
MI4748940Medicaid