Provider Demographics
NPI:1427161678
Name:COLEMAN, DEBORAH K (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:K
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5112 CHOKEBERRY DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5396
Mailing Address - Country:US
Mailing Address - Phone:630-904-7361
Mailing Address - Fax:
Practice Address - Street 1:5112 CHOKEBERRY DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5396
Practice Address - Country:US
Practice Address - Phone:630-904-7361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2010-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-091588207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3633309286030501Medicaid
IL1619414OtherBCBS GROUP
IL3633309286030501Medicaid
IL1619414OtherBCBS GROUP