Healthcare Provider Details

I. General information

NPI: 1417338609
Provider Name (Legal Business Name): TIFFANY COLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 ARLINGTON ST
INKSTER MI
48141-4011
US

IV. Provider business mailing address

600 ARLINGTON ST
INKSTER MI
48141-4011
US

V. Phone/Fax

Practice location:
  • Phone: 313-283-4696
  • Fax:
Mailing address:
  • Phone: 313-283-4696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License NumberC455793630605
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: