Basic Information
| Provider Information | |||||||||
| NPI: | 1750360327 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLEMAN | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13131 TESSON FERRY RD | ||||||||
| Address2: | SUITE #105 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631283887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147568035 | ||||||||
| FaxNumber: | 3147568050 | ||||||||
| Practice Location | |||||||||
| Address1: | 13131 TESSON FERRY RD | ||||||||
| Address2: | SUITE #105 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631283887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147568035 | ||||||||
| FaxNumber: | 3147568050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2006 | ||||||||
| LastUpdateDate: | 06/24/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 105164 | MO | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | 105164 | MO | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 206944605 | 05 | MO | MEDICAID |