1134947914 NPI number — MISS LINDSEY CARLISA COLEMAN STUDENT AND EMPLOYEE

Table of content: MISS LINDSEY CARLISA COLEMAN STUDENT AND EMPLOYEE (NPI 1134947914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134947914 NPI number — MISS LINDSEY CARLISA COLEMAN STUDENT AND EMPLOYEE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLEMAN
Provider First Name:
LINDSEY
Provider Middle Name:
CARLISA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
STUDENT AND EMPLOYEE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134947914
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 S DOUGLAS RD STE 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORAL GABLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33134-4108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-244-1818
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29429 JOHN R RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON HEIGHTS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48071-2565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-940-3592
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X , with the licence number:  0 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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