Provider Demographics
NPI:1194768358
Name:COLEMAN, CHAD EDWARD (MD)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:EDWARD
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 S MIDLOTHIAN PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5591
Mailing Address - Country:US
Mailing Address - Phone:972-723-1474
Mailing Address - Fax:972-723-9423
Practice Address - Street 1:1441 S MIDLOTHIAN PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-5591
Practice Address - Country:US
Practice Address - Phone:972-723-1474
Practice Address - Fax:972-723-9423
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7698207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1036337-01Medicaid
TX103633705Medicaid
TX81839SOtherBCBS
TX8BR064OtherBCBS
TXP00681500Medicare PIN
TX8BR064OtherBCBS
TXH09488Medicare UPIN
TX8F3682Medicare PIN
TX81839SOtherBCBS