Provider Demographics
NPI:1235399825
Name:COLEMAN, MICHELE KAY (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:KAY
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:414 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-3935
Mailing Address - Country:US
Mailing Address - Phone:360-630-0072
Mailing Address - Fax:360-336-0126
Practice Address - Street 1:125 N 18TH ST
Practice Address - Street 2:SUITE 'B'
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-3902
Practice Address - Country:US
Practice Address - Phone:360-360-0072
Practice Address - Fax:360-336-0126
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60188169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA277343OtherLABOR & INDUSTRIES
WAG8898536Medicare Oscar/Certification