Healthcare Provider Details

I. General information

NPI: 1669835963
Provider Name (Legal Business Name): TAYLOR DRAKE COLEMAN I MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10110 DONALD S POWERS DR STE 202
MUNSTER IN
46321-4070
US

IV. Provider business mailing address

8558 BROADWAY
MERRILLVILLE IN
46410-7032
US

V. Phone/Fax

Practice location:
  • Phone: 219-922-8222
  • Fax: 219-922-8899
Mailing address:
  • Phone: 219-239-2170
  • Fax: 219-270-3168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01085218A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: