| Glennetta Coleman Md And Associates, Ltd | |
|
1983 Daimler Road Rockford IL 61112-1081 | |
| (815) 227-0055 | |
| (815) 227-0050 |
| Full Name | Glennetta Coleman Md And Associates, Ltd |
|---|---|
| Speciality | Internal Medicine |
| Location | 1983 Daimler Road, Rockford, Illinois |
| Authorized Official Name and Position | Tricia Olagues (PRACTICE MANAGER) |
| Authorized Official Contact | 8152270055 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Glennetta Coleman Md And Associates, Ltd 1893 Daimler Rd Rockford IL 61112-1081 Ph: (815) 227-0055 | Glennetta Coleman Md And Associates, Ltd 1983 Daimler Road Rockford IL 61112-1081 Ph: (815) 227-0055 |
| NPI Number | 1184667438 |
|---|---|
| Provider Enumeration Date | 06/14/2006 |
| Last Update Date | 08/06/2024 |
| Medicare PECOS PAC ID | 0143226787 |
|---|---|
| Medicare Enrollment ID | O20061004000668 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184667438 | NPI | - | NPPES |
| 036-06741 | Medicaid | IL | |
| 0031603167 | Other | IL | BCBS OF ILLINOIS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| Provider Name | Glennetta M Coleman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063449296 PECOS PAC ID: 8325044969 Enrollment ID: I20061004000666 |
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