Provider Demographics
NPI:1669835963
Name:COLEMAN, TAYLOR DRAKE I (MD)
Entity type:Individual
Prefix:MR
First Name:TAYLOR
Middle Name:DRAKE
Last Name:COLEMAN
Suffix:I
Gender:M
Credentials:MD
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Mailing Address - Street 1:8558 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7032
Mailing Address - Country:US
Mailing Address - Phone:219-239-2170
Mailing Address - Fax:219-270-3168
Practice Address - Street 1:10110 DONALD S POWERS DR STE 202
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-4070
Practice Address - Country:US
Practice Address - Phone:219-922-8222
Practice Address - Fax:219-922-8899
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01085218A208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program