Provider Demographics
NPI:1205974425
Name:DR. WALTER B. COLEMAN PC
Entity type:Organization
Organization Name:DR. WALTER B. COLEMAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT.
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:B
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:STE 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:
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?:Yes
Parent Organization LBN:DR. WALTER B COLEMAN PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-01
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0621950001Medicare NSC