Healthcare Provider Details

I. General information

NPI: 1558396606
Provider Name (Legal Business Name): DAVID B COLEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 ROXBURY RD
ROCKFORD IL
61107-5059
US

IV. Provider business mailing address

444 ROXBURY RD
ROCKFORD IL
61107-5059
US

V. Phone/Fax

Practice location:
  • Phone: 815-398-3000
  • Fax: 815-391-5076
Mailing address:
  • Phone: 815-398-3000
  • Fax: 815-391-5076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036167820
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number036167820
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: