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General NPI Number Information
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NPI Number | 1225219728
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Entity Type | Organization
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Legal Business Name | MOMMY AND ME MATERNAL PAMPERING AND FETAL ASSESSMENT CENTER, LLC
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Dates
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Enumeration Date | 11/26/2007
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Last Update Date | 11/03/2010
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Provider Practice Location Address
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Address Line | 33026 NORTHWESTERN HWY
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3634
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Country | US
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Telephone | 248-851-6667
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Fax | 248-851-6668
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Provider Business Mailing Address
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Address Line | PO BOX 2660
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City | FARMINGTON HILLS
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State | MI
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Zip | 48333-2660
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Country | US
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Telephone | 248-851-6667
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Fax | 248-851-6668
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Authorized Official
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Title or Position | OWNER/ FOUNDER
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Name | DR. LANETTA ANDREA COLEMAN
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Credential | MD
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Telephone | 313-598-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 430060101
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License Number State | MI
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