Healthcare Provider Details

I. General information

NPI: 1700846995
Provider Name (Legal Business Name): JOHN MICHAEL COLEMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 NORTH SMITH AVE SUITE 505
SAINT PAUL MN
55102-3367
US

IV. Provider business mailing address

4770 WHITE BEAR PARKWAY, LL
WHITE BEAR LAKE MN
55110-3394
US

V. Phone/Fax

Practice location:
  • Phone: 651-220-6260
  • Fax: 651-220-7777
Mailing address:
  • Phone: 651-426-0698
  • Fax: 651-426-6439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMN24195
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number24195
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: