Provider Demographics
NPI:1710011705
Name:COLEMAN, KATARI I (DT)
Entity Type:Individual
Prefix:MS
First Name:KATARI
Middle Name:I
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:DT
Other - Prefix:MS
Other - First Name:KATARI
Other - Middle Name:I
Other - Last Name:COLEMAN-DANIELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DT
Mailing Address - Street 1:10747 S COTTAGE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-3809
Mailing Address - Country:US
Mailing Address - Phone:773-264-0928
Mailing Address - Fax:
Practice Address - Street 1:10747 S COTTAGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-3809
Practice Address - Country:US
Practice Address - Phone:773-264-0928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILKC71971001P174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist