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General NPI Number Information
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NPI Number | 1093684524
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Entity Type | Individual
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Provider Name | SHANTINQUE COLEMAN
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Gender | Female
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Dates
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Enumeration Date | 11/03/2025
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 15600 19 MILE RD
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City | CLINTON TWP
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State | MI
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Zip | 48038-3502
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Country | US
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Telephone | 586-263-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 2534 LAFAY DR
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48324-1745
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Country | US
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Telephone | 248-904-3781
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 6851117195
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License Number State | MI
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