Provider Demographics
NPI:1861613580
Name:COMAN, JOSEPH M II (SP)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:COMAN
Suffix:II
Gender:M
Credentials:SP
Other - Prefix:
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:COMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1049
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46624-1049
Mailing Address - Country:US
Mailing Address - Phone:574-289-4831
Mailing Address - Fax:574-234-2075
Practice Address - Street 1:2505 E JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-2635
Practice Address - Country:US
Practice Address - Phone:574-289-4831
Practice Address - Fax:574-234-2075
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002390A235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200623120Medicaid
IN3000011276Medicaid