GLEN COULOMB (NPI# 1396705489) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396705489 |
| Entity Type | Individual |
| Full Name | GLEN COULOMB |
| Credential | MD |
| Practice Address |
801 S Washington St Naperville IL 60540-7430 |
| Mailing Address |
1919 S Highland Ave Ste B202 Lombard IL 60148-6153 |
| Practice Telephone | 6302812670 |
| Practice Fax Number | 8153272475 |
| Mailing Telephone | 6308737305 |
| Mailing Fax Number | 6304163189 |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2011-02-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
036063012 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BLUE CROSS BLUE SHIELD | 02215038 | 01 |
| Street Address |
801 S WASHINGTON ST |
| City | NAPERVILLE |
| State | IL |
| Zip Code | 60540-7430 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790772457 | Stephen P Baldwin | Internal Medicine | 801 S Washington St, 3rd Floor, Naperville, IL 60540-7430 | 2005-09-28 |
| 1528680360 | Jennifer Lynne Hemmer | Nurse Practitioner | 801 S Washington St, Naperville, IL 60540-7430 | 2020-05-14 |
| 1174006290 | Mary Lyons | Clinical Nurse Specialist | 801 S Washington St, Naperville, IL 60540-7430 | 2018-09-13 |
| 1164902318 | Clayton Shelton | Physician Assistant | 801 S Washington St, Naperville, IL 60540-7430 | 2018-08-17 |
| 1891287926 | Ashley Katherine Pinckney | Nurse Practitioner | 801 S Washington St, Naperville, IL 60540-7430 | 2018-06-04 |
| 1174029615 | Heather Mcleland | Nurse Practitioner | 801 S Washington St, Naperville, IL 60540-7499 | 2018-04-03 |
| 1225540305 | Mary E Gardner | Dietitian, Registered | 801 S Washington St, Naperville, IL 60540-7430 | 2017-10-30 |
| 1457877839 | Kaitlyn Rose Rosales | Registered Nurse | 801 S Washington St, Naperville, IL 60540-7430 | 2017-08-17 |
| 1124559117 | Maulik Patel | Internal Medicine | 801 S Washington St, Naperville, IL 60540-7499 | 2017-03-22 |
| 1568903565 | Associated Pathologists and Laboratory Physicians, LLC | Pathology | 801 S Washington St, Edward Hospital Pathology, Naperville, IL 60540-7430 | 2017-03-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760007678 | Mandalai Oral and Maxillofacial Surgery PC | Oral & Maxillofacial Surgery | 720 S. Brom Drive Suite 103, Naperville, IL 60540 | 2020-06-16 |
| 1316418957 | James Edward Frank | Counselor | 600 South Washington Street, Suite 302, Naperville, IL 60540 | 2018-12-07 |
| 1093208332 | Ingrid Johnson | Developmental Therapist | Right Start Pediatric Therapies, 50 S Main St Suite 200, Naperville, IL 60540 | 2018-06-12 |
| 1225528524 | Tara Rada Nieberding | Contractor | 1701 Quincy Ave Ste 12, Naperville, IL 60540 | 2018-05-14 |
| 1588182190 | Debra Xiangjun Hayes | Acupuncturist | 226 N Washington St # 2, Naperville, IL 60540 | 2017-09-03 |
| 1487197166 | Health Improvement and Preventive Services LLC | Family Medicine | 1979 Mcdowell Rd., Suite 103, Naperville, IL 60540 | 2016-11-29 |
| 1588013775 | Matthew Jacob Imber | Chiropractor | 1220 Hobson Rd Ste 220, Naperville, IL 60540 | 2016-06-08 |
| 1457711418 | Elite Pain Medical Group Inc | Physical Medicine & Rehabilitation | 720 South Brom Drive, Suite 201, Naperville, IL 60540 | 2016-03-03 |
| 1265814800 | Jenifer Lynn Mersman | Chiropractor | 475 River Bend Rd. Suite 104, Naperville, IL 60540 | 2015-06-19 |
| 1386038016 | Jonathon Martin Ruiz | Specialist/Technologist | 440 N Brainard Street, Naperville, IL 60540 | 2015-03-19 |
| Find all providers in zip 60540 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417913161 | James Walsh | Surgery | 801 S Washington, Naperville, IL 60540 | 2006-04-21 |
| 1700887684 | Thomas A. Painter | Surgery | 1020 E Ogden Ave Ste 301, Naperville, IL 60563-8611 | 2005-08-02 |
| 1316266976 | Valerie Takyi | Surgery | 1020 E Ogden Ave Ste 301, Naperville, IL 60563-8611 | 2010-05-21 |
| 1346292547 | Samer F Najjar | Surgery | 1020 E Ogden Ave Ste 301, Naperville, IL 60563-8611 | 2006-05-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396267324 | Congress Vascular Center LLC | Surgery | 41 W Congress Pkwy Fl 1, Chicago, IL 60605-1531 | 2017-07-11 |
| 1043731300 | Elmwood Park Vascular Center LLC | Surgery | 7230 W North Ave Ste 108, Elmwood Park, IL 60707-4261 | 2017-06-27 |
| 1588105811 | Mickey Graphia | Surgery | 701 N 1st St # D346, Springfield, IL 62702 | 2017-03-20 |
| 1992126668 | Vascular Specialists LLC | Surgery | 20060 Governors Dr Ste 102, Olympia Fields, IL 60461-1099 | 2013-12-26 |
| 1588959548 | Patrick Michael Sullivan Neville | Surgery | 4600 Memorial Dr Ste 120, Belleville, IL 62226-5359 | 2011-06-17 |
| 1235454968 | Margaret Claire Rigamer | Surgery | 1901 W Harrison St Dept Of, Chicago, IL 60612-3714 | 2010-04-06 |
| 1215251541 | John V. White, Md, LLC | Surgery | 8816 W Dempster St, Niles, IL 60714-5109 | 2010-03-15 |
| 1710212733 | Vascular Surgery and Interpretation S.c. | Surgery | 3330 W 177th St Ste 2c1, Hazel Crest, IL 60429-2184 | 2009-10-08 |
| 1538391792 | Usa Vein Clinics of Chicago LLC | Surgery | 4141 Dundee Rd, Northbrook, IL 60062-2129 | 2009-08-20 |
| 1306010731 | Tanq, Inc. | Surgery | 18510 S Marilynn Ct, Mokena, IL 60448-9517 | 2008-04-16 |
| Find all providers with the same taxonomy | ||||
| City | NAPERVILLE |
| Zip Code | 60540 |
Please comment or provide details below to improve the information on GLEN COULOMB.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.