Healthcare Provider Details

I. General information

NPI: 1598113300
Provider Name (Legal Business Name): KYLE JACOB COLEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2354 W BOULEVARD
KOKOMO IN
46902-6069
US

IV. Provider business mailing address

2354 W BOULEVARD
KOKOMO IN
46902-6069
US

V. Phone/Fax

Practice location:
  • Phone: 765-457-4800
  • Fax: 317-583-2519
Mailing address:
  • Phone: 765-457-4800
  • Fax: 317-583-2519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberDR.0063885
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01084244A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: