Provider Demographics
NPI:1427046176
Name:COLMAN, RICHARD J (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:COLMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4861 KEW CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48301-3516
Mailing Address - Country:US
Mailing Address - Phone:248-851-2301
Mailing Address - Fax:
Practice Address - Street 1:11885 E 12 MILE RD
Practice Address - Street 2:202A
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3474
Practice Address - Country:US
Practice Address - Phone:586-582-7060
Practice Address - Fax:586-582-7051
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006109207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4684899Medicaid
5101006109OtherCONTROLLED SUBSTANCE
AC4415508OtherDEA
ON2110019Medicare ID - Type Unspecified
MI4684899Medicaid