Healthcare Provider Details

I. General information

NPI: 1457469330
Provider Name (Legal Business Name): ERIC N. COFFMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 01/09/2025
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4333 STONY RIVER DR
BLOOMFIELD MI
48301-3650
US

IV. Provider business mailing address

20331 FARMINGTON RD
LIVONIA MI
48152-1411
US

V. Phone/Fax

Practice location:
  • Phone: 313-402-8381
  • Fax:
Mailing address:
  • Phone: 248-474-5601
  • Fax: 248-474-5618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number5101007287
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: