Provider Demographics
NPI:1962473157
Name:COLEMAN, MICHELE LYNN (MD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LYNN
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:LYNN
Other - Last Name:KRATZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-2420
Mailing Address - Fax:
Practice Address - Street 1:5818 N NEVADA AVE STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3505
Practice Address - Country:US
Practice Address - Phone:719-599-0444
Practice Address - Fax:719-365-7150
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO48751207Q00000X
OH35. 070982207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2092702Medicaid
CO43633340Medicaid
OH2092702Medicaid
CO43633340Medicaid