Provider Demographics
NPI:1033150032
Name:COLEMAN, LANETTA (MD)
Entity Type:Individual
Prefix:
First Name:LANETTA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 W OUTER DR
Mailing Address - Street 2:#400
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235
Mailing Address - Country:US
Mailing Address - Phone:313-966-4200
Mailing Address - Fax:313-966-3560
Practice Address - Street 1:6001 W OUTER DR
Practice Address - Street 2:#400
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235
Practice Address - Country:US
Practice Address - Phone:313-966-4200
Practice Address - Fax:313-966-3560
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILC060101207VG0400X
MI4301060101207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104536439Medicaid
ON62850003Medicare ID - Type Unspecified
G33856Medicare UPIN
MI104536439Medicaid