Healthcare Provider Details

I. General information

NPI: 1962324608
Provider Name (Legal Business Name): MARIEME E KOFFLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 W FRANKLIN ST STE 1
JACKSON MI
49201-2148
US

IV. Provider business mailing address

330 W FRANKLIN ST STE 1
JACKSON MI
49201-2148
US

V. Phone/Fax

Practice location:
  • Phone: 517-788-9147
  • Fax: 517-769-5051
Mailing address:
  • Phone: 517-788-9147
  • Fax: 517-769-5051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: