Healthcare Provider Details

I. General information

NPI: 1508882275
Provider Name (Legal Business Name): MARVIN K COY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 S MAIN ST
CHEBOYGAN MI
49721-2220
US

IV. Provider business mailing address

PO BOX 419
CHEBOYGAN MI
49721-0419
US

V. Phone/Fax

Practice location:
  • Phone: 231-627-1493
  • Fax: 231-627-1492
Mailing address:
  • Phone: 231-627-1438
  • Fax: 231-627-1471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5101008864
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: