Provider Demographics
NPI:1972510378
Name:COATES, ALLAN G (DO)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:G
Last Name:COATES
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 1:2093 HEALTH DRIVE SW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519
Mailing Address - Country:US
Mailing Address - Phone:616-452-7099
Mailing Address - Fax:616-452-4142
Practice Address - Street 1:2093 HEALTH DRIVE SW
Practice Address - Street 2:SUITE 201
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519
Practice Address - Country:US
Practice Address - Phone:616-452-7099
Practice Address - Fax:616-452-4142
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAC007888207RG0100X
MI510100788207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1679311Medicaid
MIOD16398Medicare ID - Type Unspecified
MIA76612Medicare UPIN