Individual
GLEN COULOMB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 S WASHINGTON ST, NAPERVILLE, IL 60540-7430
(630) 281-2670
(815) 327-2475
Mailing address
1919 S HIGHLAND AVE, STE B202, LOMBARD, IL 60148-6153
(630) 873-7305
(630) 416-3189
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
036063012
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02215038
BLUE CROSS BLUE SHIELD
IL
Enumeration date
03/24/2006
Last updated
02/22/2011
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