Provider Demographics
NPI:1871576264
Name:COATES, LAKIMERLY MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:LAKIMERLY
Middle Name:MICHELLE
Last Name:COATES
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:LAKIMERLY
Other - Middle Name:MICHELLE
Other - Last Name:WOODS-COATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4338 MORSAY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-4877
Mailing Address - Country:US
Mailing Address - Phone:815-399-6400
Mailing Address - Fax:815-399-4424
Practice Address - Street 1:4338 MORSAY DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-4877
Practice Address - Country:US
Practice Address - Phone:815-399-6400
Practice Address - Fax:815-399-4424
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC199443207N00000X
IL036102903207ND0101X, 207ND0900X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10132043OtherBCBS
IL036102903Medicaid
IL14D1043269OtherCLIA
IL10132043OtherBCBS
ILH44639Medicare UPIN
IL14D1043269OtherCLIA