MEDICARE: DR. DAVID MICHAEL COE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	E0001896	OH
2	103TC0700X	Clinical Psychologist	5909	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000363003	OTHER	OH	ANTHEM BLUE SHIELD
2	000000363003	OTHER	OH	UNICARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932100260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID MICHAEL COE PH.D.

Provider Business Mailing Address
First Line	:	438 MAIN ST
Second Line	:
City	:	CONNEAUT
State	:	OH
Zip	:	44030-2609
Country	:	US
Telephone Number	:	440-593-2630
Fax Number	:	440-599-9074

Provider Business Practice Location Address
First Line	:	438 MAIN ST
Second Line	:
City	:	CONNEAUT
State	:	OH
Zip	:	44030-2609
Country	:	US
Telephone Number	:	440-593-2630
Fax Number	:	440-599-9074

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	12/07/2007

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