MEDICARE: DR. HENRY JOSEPH COLEMAN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	5101007227	MI
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	OS 11774	FL

General Provider Information

NPI Number	:	1215266366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY JOSEPH COLEMAN D.O.

Provider Business Mailing Address
First Line	:	401 E LAS OLAS BLVD
Second Line	:	SUITE 130-153
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2210
Country	:	US
Telephone Number	:	954-272-8425
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 E LAS OLAS BLVD
Second Line	:	SUITE 130-153
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2210
Country	:	US
Telephone Number	:	954-272-8425
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2009
Last Update Date	:	07/02/2012

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