Healthcare Provider Details

I. General information

NPI: 1205974425
Provider Name (Legal Business Name): DR. WALTER B. COLEMAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 04/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 15 MILE RD
STERLING HEIGHTS MI
48312-3611
US

IV. Provider business mailing address

9001 15 MILE RD STE A
STERLING HEIGHTS MI
48312-3611
US

V. Phone/Fax

Practice location:
  • Phone: 586-979-0560
  • Fax: 586-979-8766
Mailing address:
  • Phone: 586-979-0560
  • Fax: 586-979-8766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. WALTER B COLEMAN
Title or Position: PRESIDENT.
Credential: D.P.M.
Phone: 586-979-0560