Provider Demographics
NPI:1821307976
Name:CLIFFORD L COLEMAN & ASSOCIATES LTD
Entity Type:Organization
Organization Name:CLIFFORD L COLEMAN & ASSOCIATES LTD
Other - Org Name:CLIFFORD L. COLEMAN, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:LOREN
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-549-3388
Mailing Address - Street 1:1155 CEDAR CT
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-5333
Mailing Address - Country:US
Mailing Address - Phone:618-549-3388
Mailing Address - Fax:618-549-3380
Practice Address - Street 1:1155 CEDAR CT
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-5333
Practice Address - Country:US
Practice Address - Phone:618-549-3388
Practice Address - Fax:618-549-3380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036060385174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036060385Medicaid
IL654350Medicare UPIN