Organization Name: | GLENNETTA COLEMAN MD AND ASSOCIATES, LTD |
NPI Number: | 1184667438 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GLENNETTA COLEMAN (PHYSICIAN OWNER) |
Mailing Address: | 1983 Daimler Road Rockford |
State: | IL US |
Postal Code: | 611121081 |
Phone Number: | 8152270055 |
Fax Number: | 8152270050 |
NPI Enumeration Date: | 06/14/2006 |
NPI Last Update Date: | 12/18/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 036067471 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |