Provider Demographics
NPI:1578322319
Name:COFFEY, ROBERT FRANKLIN
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:FRANKLIN
Last Name:COFFEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3514 N WILTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-8038
Mailing Address - Country:US
Mailing Address - Phone:616-648-9718
Mailing Address - Fax:
Practice Address - Street 1:3514 N WILTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-8038
Practice Address - Country:US
Practice Address - Phone:616-648-9718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant