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General NPI Number Information
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NPI Number | 1184667438
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Entity Type | Organization
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Legal Business Name | GLENNETTA COLEMAN MD AND ASSOCIATES, LTD
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 1983 DAIMLER ROAD
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City | ROCKFORD
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State | IL
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Zip | 61112-1081
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Country | US
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Telephone | 815-227-0055
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Fax | 815-227-0050
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Provider Business Mailing Address
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Address Line | 1893 DAIMLER RD
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City | ROCKFORD
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State | IL
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Zip | 61112-1081
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Country | US
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Telephone | 815-227-0055
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Fax | 815-227-0050
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | TRICIA OLAGUES
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Credential | RN
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Telephone | 815-227-0055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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