Provider Demographics
NPI:1225077365
Name:COLEMAN, RICKY J (DO)
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:J
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4672 HILL ST
Mailing Address - Street 2:
Mailing Address - City:CASS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48726-1028
Mailing Address - Country:US
Mailing Address - Phone:989-872-2121
Mailing Address - Fax:989-872-5376
Practice Address - Street 1:4672 HILL ST
Practice Address - Street 2:
Practice Address - City:CASS CITY
Practice Address - State:MI
Practice Address - Zip Code:48726-1028
Practice Address - Country:US
Practice Address - Phone:989-872-2121
Practice Address - Fax:989-872-5376
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012917207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG96007065Medicare ID - Type Unspecified