Provider Demographics
NPI:1467531350
Name:COLEMAN, KIMBERLEE (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLEE
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 1:43097 WOODWARD AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5041
Mailing Address - Country:US
Mailing Address - Phone:248-454-9000
Mailing Address - Fax:248-454-9100
Practice Address - Street 1:43097 WOODWARD AVE
Practice Address - Street 2:STE 201
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5041
Practice Address - Country:US
Practice Address - Phone:248-454-9000
Practice Address - Fax:248-454-9100
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067190208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF77536Medicare UPIN