=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326214339
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANIEL C COFFEY MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2008
-----------------------------------------------------
Last Update Date | 06/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 737 N GRAND AVE
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48906-5160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-372-0500
-----------------------------------------------------
Fax | 517-482-3220
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 737 N GRAND AVE
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48906-5160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-372-0500
-----------------------------------------------------
Fax | 517-482-3220
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SURGEON
-----------------------------------------------------
Name | DR. DANIEL CHRISTOPHER COFFEY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 527-372-0500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208C00000X
-----------------------------------------------------
Taxonomy Name | Colon & Rectal Surgery Physician
-----------------------------------------------------
License Number | 4301074515
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------