Provider Demographics
NPI:1679511828
Name:COLEMAN, KIM L (MD)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:L
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 7239
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-0239
Mailing Address - Country:US
Mailing Address - Phone:402-481-6000
Mailing Address - Fax:402-423-4100
Practice Address - Street 1:3901 PINE LAKE RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5497
Practice Address - Country:US
Practice Address - Phone:402-481-6000
Practice Address - Fax:402-423-4100
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE204982085P0229X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE03886OtherBCBS
NE47078180813Medicaid
NENA1330018OtherSMI MEDICARE PIN
IA0550236Medicaid
NE300113527OtherRR MEDICARE
KS100366310AMedicaid
NE281978OtherAMI MEDICARE PIN
NE03145OtherBLUE CROSS BLUE SHIELD
NE47078180813Medicaid
KS100366310AMedicaid