Provider Demographics
NPI:1508898404
Name:COLEMAN, MAILA A (MD)
Entity Type:Individual
Prefix:DR
First Name:MAILA
Middle Name:A
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 1:1127 S GEORGE NIGH EXPY
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-7143
Mailing Address - Country:US
Mailing Address - Phone:918-423-8440
Mailing Address - Fax:918-421-2938
Practice Address - Street 1:1127 S GEORGE NIGH EXPY
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-7143
Practice Address - Country:US
Practice Address - Phone:918-423-8440
Practice Address - Fax:918-421-2938
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-10629208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00D0216590OtherHMSA