Healthcare Provider Details

I. General information

NPI: 1417288812
Provider Name (Legal Business Name): ARBOR MEDICAL COFFMAN & FOX,D.O.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 01/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27550 JOY RD
LIVONIA MI
48150-4145
US

IV. Provider business mailing address

27550 JOY RD
LIVONIA MI
48150-4145
US

V. Phone/Fax

Practice location:
  • Phone: 734-261-3290
  • Fax: 734-261-0775
Mailing address:
  • Phone: 734-261-3290
  • Fax: 734-261-0775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberB7101
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101007287
License Number State

VIII. Authorized Official

Name: DR. ERIC N COFFMAN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 734-261-3290