Coleman, Glennetta
Coleman, Glennetta is an sole proprietor health care provider with primary practice located at 1893 Daimler Rd , Rockford IL 61112-1081. She recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is her primary health care specialty. Coleman, Glennetta can be contacted via phone (815) 227-0055.Contact Information
Primary practice address
1893 Daimler Rd
Rockford IL 61112-1081
Phone: (815) 227-0055
Fax: (815) 227-0050
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 036067471 | Illinois |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 036037471 | Illinois |
Profile Details
| NPI number | 1063449296 |
|---|---|
| LBN Legal business name | Coleman, Glennetta |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 26th, 2006 |
| Last updated | Aug 1st, 2023 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1063449296 | NPPES |
| Illinois | MEDICAID | 036-06741 | |
| Illinois | Other | 0031603167 |
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