Provider Demographics
NPI:1235195272
Name:COLEMAN, MAE M (MD)
Entity Type:Individual
Prefix:DR
First Name:MAE
Middle Name:M
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1500 CONCORD TER
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2815
Mailing Address - Country:US
Mailing Address - Phone:800-243-3839
Mailing Address - Fax:954-858-0404
Practice Address - Street 1:4201 BELFORT RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1431
Practice Address - Country:US
Practice Address - Phone:904-296-3700
Practice Address - Fax:954-858-0404
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME850702080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265061400Medicaid
FLE7715Medicare ID - Type Unspecified
FL265061400Medicaid