1700837044 NPI number — DR. KIMBERLEE A COLEMAN MD

Table of content: DR. DANIEL P CANNUCCIARI M.D. (NPI 1629061106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700837044 NPI number — DR. KIMBERLEE A COLEMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLEMAN
Provider First Name:
KIMBERLEE
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLEMAN HENDERSON
Provider Other First Name:
KIMBERLEE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700837044
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2625 NE 14TH AVE APT 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILTON MANORS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33334-4395
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-809-3365
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2625 NE 14TH AVE APT 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILTON MANORS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33334-4395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-809-3365
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2006

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: 207V00000X , with the licence number:  0057591 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: ME146906 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X , with the licence number: N4358 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 207600202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 207600201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2076002-03 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 108272300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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