Healthcare Provider Details

I. General information

NPI: 1033150032
Provider Name (Legal Business Name): LANETTA COLEMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 W OUTER DR #400
DETROIT MI
48235
US

IV. Provider business mailing address

6001 W OUTER DR #400
DETROIT MI
48235
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-4200
  • Fax: 313-966-3560
Mailing address:
  • Phone: 313-966-4200
  • Fax: 313-966-3560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberLC060101
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301060101
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: