Healthcare Provider Details

I. General information

NPI: 1073365532
Provider Name (Legal Business Name): GIA COLEMAN CBCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11009 S WENTWORTH AVE
CHICAGO IL
60628-4220
US

IV. Provider business mailing address

5401 W LAWRENCE AVE UNIT 300861
CHICAGO IL
60630-2778
US

V. Phone/Fax

Practice location:
  • Phone: 773-912-8722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246Y00000X
TaxonomyHealth Information Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: