Healthcare Provider Details

I. General information

NPI: 1871576264
Provider Name (Legal Business Name): LAKIMERLY MICHELLE COATES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAKIMERLY MICHELLE WOODS-COATES MD

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 03/11/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4338 MORSAY DR
ROCKFORD IL
61107-4877
US

IV. Provider business mailing address

4338 MORSAY DR
ROCKFORD IL
61107-4877
US

V. Phone/Fax

Practice location:
  • Phone: 815-399-6400
  • Fax: 815-399-4424
Mailing address:
  • Phone: 815-399-6400
  • Fax: 815-399-4424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberC199443
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number036102903
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number036102903
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number036102903
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036102903
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: