Basic Information
| Provider Information | |||||||||
| NPI: | 1316963135 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COFFEY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24701 EUCLID AVE | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | EUCLID | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441171714 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 11100 EUCLID AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441061716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2168441700 | ||||||||
| FaxNumber: | 2162866341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 10/27/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | 35-076346 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085B0100X | 35-076346 | OH | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085D0003X | 35-076346 | OH | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Neuroimaging | 2085R0202X | 35-076346 | OH | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085U0001X | 35-076346 | OH | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | 2085H0002X | 35-076346 | OH | N | Allopathic & Osteopathic Physicians | Radiology | Hospice and Palliative Medicine | 2085N0904X | 35-076346 | OH | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085P0229X | 35-076346 | OH | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0001X | 35-076346 | OH | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0203X | 35-076346 | OH | N | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology | 2085R0204X | 35-076346 | OH | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 207U00000X | 35-076346 | OH | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | 207UN0903X | 35-076346 | OH | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | In Vivo & In Vitro Nuclear Medicine | 207UN0901X | 35-076346 | OH | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology | 207UN0902X | 35-076346 | OH | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Imaging & Therapy |
ID Information
| ID | Type | State | Issuer | Description | 2303831 | 05 | OH | MEDICAID | 363432 | 01 | OH | WELLCARE | OTHER | 1010331610001 | 05 | PA | MEDICAID | 0304914 | 01 | OH | BCMH | OTHER | Q76346 | 05 | OH | MEDICAID | 000000204722 | 01 | OH | UNISON | OTHER | 7308348 | 01 | OH | AETNA | OTHER | 000000503579 | 01 | OH | ANTHEM | OTHER | P00358782 | 01 | OH | RAILROAD MEDICARE | OTHER | 732284 | 01 | OH | BUCKEYE | OTHER | 1316963135 | 05 | MI | MEDICAID |