Provider Demographics
NPI:1215260534
Name:MICHAEL A, COFFEY MD PA
Entity type:Organization
Organization Name:MICHAEL A, COFFEY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-766-4777
Mailing Address - Street 1:2400 HARBOR BLVD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5052
Mailing Address - Country:US
Mailing Address - Phone:941-766-4777
Mailing Address - Fax:941-766-4778
Practice Address - Street 1:2400 HARBOR BLVD
Practice Address - Street 2:SUITE 14
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5052
Practice Address - Country:US
Practice Address - Phone:941-766-4777
Practice Address - Fax:941-766-4778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0052053207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257805100Medicaid
FL07739YMedicare UPIN