Healthcare Provider Details

I. General information

NPI: 1952216509
Provider Name (Legal Business Name): KEVIN DANIEL COLEMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48325 MICHIGAN AVE.
CANTON MI
48188
US

IV. Provider business mailing address

222 CLINTON ST
MILFORD MI
48381-1814
US

V. Phone/Fax

Practice location:
  • Phone: 254-749-8686
  • Fax:
Mailing address:
  • Phone: 254-749-8686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: