Healthcare Provider Details

I. General information

NPI: 1225234446
Provider Name (Legal Business Name): LEE MAURICE COLEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1896
US

IV. Provider business mailing address

1540 LAKE LANSING RD STE G6
LANSING MI
48912-3757
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-4340
  • Fax:
Mailing address:
  • Phone: 517-482-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA89831
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301504013
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: