Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 1245 | MN |
NPI | 1083719561 |
---|---|
Provider Name | Dr. Lyle Charles Coleman |
First Address | Owatonna, MN 55060-3959 |
Second Address | Owatonna, MN 55060-3959 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 10/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
138401300 | DOL PROVIDER NUMBER (01) | |
359000285 | (02) | MN |
905225900 | (05) | MN |
T65411 | (02) | MN |