Provider Demographics
NPI:1487248662
Name:COLEMAN, RODNEY JOHN (CP)
Entity type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:JOHN
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G1101 N BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-4497
Mailing Address - Country:US
Mailing Address - Phone:810-234-6582
Mailing Address - Fax:
Practice Address - Street 1:G1101 N BALLENGER HWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-4497
Practice Address - Country:US
Practice Address - Phone:810-234-6582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-27
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICP0003282224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist