Provider Demographics
NPI:1598934952
Name:DR. WALTER B COLEMAN P.C.
Entity Type:Organization
Organization Name:DR. WALTER B COLEMAN P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-979-0560
Mailing Address - Street 1:9001 15 MILE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-3611
Mailing Address - Country:US
Mailing Address - Phone:586-979-0560
Mailing Address - Fax:586-979-8766
Practice Address - Street 1:9001 15 MILE RD
Practice Address - Street 2:SUITE A
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-3611
Practice Address - Country:US
Practice Address - Phone:586-979-0560
Practice Address - Fax:586-979-8766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies