Individual
JOHN B COLEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
K-14 CARDIOTHORACIC SURGERY 2799 W GRAND BLVD, DETROIT, MI 48202-3450
(313) 850-8815
Mailing address
K-14 CARDIOTHORACIC SURGERY 2799 WEST GRAND BLVD, DETROIT, MI 48202
(313) 850-8815
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601004268
MI
363AM0700X
Medical Physician Assistant
5601004268
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063053
NCCPA CERTIFICATION
MI
01
—
5601004268
PHYSICIAN ASSISTANT LICENSE
MI
Enumeration date
03/29/2007
Last updated
10/24/2023
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