# GLENNETTA COLEMAN MD AND ASSOCIATES, LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184667438
- **Authorized official:** TRICIA OLAGUES RN (PRACTICE MANAGER)
- **Authorized official phone:** (815) 227-0055

## Contact information

- **Practice address:** 1983 DAIMLER ROAD, ROCKFORD, IL 61112-1081
- **Practice address phone:** (815) 227-0055
- **Practice address fax:** (815) 227-0050
- **Mailing address:** 1893 DAIMLER RD, ROCKFORD, IL 61112-1081
- **Mailing address phone:** (815) 227-0055
- **Mailing address fax:** (815) 227-0050

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 261Q00000X | Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 06/14/2006
- **Last updated:** 08/06/2024