Healthcare Provider Details

I. General information

NPI: 1851087969
Provider Name (Legal Business Name): MICHAEL COLEMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5765 S HIL MAR CIR
DISTRICT HEIGHTS MD
20747-2974
US

IV. Provider business mailing address

1818 NEW YORK AVE NE
WASHINGTON DC
20002-1848
US

V. Phone/Fax

Practice location:
  • Phone: 240-755-1927
  • Fax:
Mailing address:
  • Phone: 202-269-2401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: