Coleman Clinic, Inc.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

COLEMAN CLINIC, INC.

Practice address

1893 Daimler Rd Ste a
Rockford, IL 61112-1081

Phone

(815) 227-0055

Fax

(815) 227-0050

NPI assigned

Oct 29, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Glennetta Coleman, MDNPI 1063449296

Title

Owner

Phone

(815) 227-0055

Specialties & licenses 1

Addresses

Other names 1

• Coleman Clinic Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Glennetta Coleman, MD

  • Internal Medicine Physician
  • Rockford, IL
  • NPI 1063449296

  Single Specialty

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610928000000",
    "number": "1962002832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1893 DAIMLER RD STE A",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611121081",
            "telephone_number": "815-227-0055",
            "fax_number": "815-227-0050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1893 DAIMLER RD STE A",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611121081",
            "telephone_number": "815-227-0055",
            "fax_number": "815-227-0050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLEMAN CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-29",
        "last_updated": "2021-01-18",
        "certification_date": "2021-01-18",
        "status": "A",
        "authorized_official_last_name": "COLEMAN",
        "authorized_official_first_name": "GLENNETTA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-227-0055",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coleman Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Maria Cobio, PHARM.D.
• Kai Codner, DDS
• Maria E Coffman, PT
• Timothy P Coggin, M.D.
• James Peter Cole Jr., D.O., F.A.C.S.
• David B Coleman, MD
• Glennetta Coleman, MD
• Veronica Michell Coleman
• Sarah E Collier, MS
• Carol Jean Collins Burchardt, LCPC

• Internal Medicine Physician in Rockford, IL
• Providers in Rockford, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.