MEDICARE: DR. SUZANNE M COLEMAN MD

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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	01061701A	IN
2	207Q00000X	Family Medicine Physician	01061701A	IN

General Provider Information

NPI Number	:	1831290956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUZANNE M COLEMAN MD

Provider Business Mailing Address
First Line	:	3420 KIRKFIELD DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-5972
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3124 E STATE BLVD STE 2B
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-4763
Country	:	US
Telephone Number	:	260-483-6373
Fax Number	:

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	02/19/2008

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