Provider Demographics
NPI:1770546103
Name:COLEMAN, PATRICIA (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:COLEMAN-MIEZAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21811 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-2793
Mailing Address - Country:US
Mailing Address - Phone:586-649-3388
Mailing Address - Fax:586-842-3766
Practice Address - Street 1:21811 KELLY RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-2793
Practice Address - Country:US
Practice Address - Phone:586-649-3388
Practice Address - Fax:586-842-3766
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0470217OtherPHP
MI4234509Medicaid
MI4234509Medicaid