Provider Demographics
NPI:1215082862
Name:COATES, MIKEL E (IDC)
Entity type:Individual
Prefix:MR
First Name:MIKEL
Middle Name:E
Last Name:COATES
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 SUHTAI CT APT 302
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6074
Mailing Address - Country:US
Mailing Address - Phone:301-592-7759
Mailing Address - Fax:
Practice Address - Street 1:1885 TERRIER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23461-2205
Practice Address - Country:US
Practice Address - Phone:757-314-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman