GLEN COULOMB MD NPI 1396705489

NPI Information

  • NPI: 1396705489
  • Provider Name: GLEN COULOMB, MD
  • Classification: Surgery - 2086S0129X
  • Specialization: Vascular Surgery
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 801 S WASHINGTON ST
    NAPERVILLE, IL
    ZIP 60540
  • Phone: (630) 281-2670

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NPI Details

Glen Coulomb, MD is a vascular surgery surgery in Naperville, IL. The provider is a surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. Glen Coulomb, MD NPI is 1396705489. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

801 S WASHINGTON ST
NAPERVILLE, IL
ZIP 60540-430
Phone: (630) 281-2670
Fax: (815) 327-2475

The NPI 1396705489 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/24/2006 and was last updated on 2/22/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12086S0129XSurgeryVascular Surgery036063012ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1L63828MEDICARE UPIN
2K36122MEDICARE ID-TYPE UNSPECIFIEDILLINOISMEDICARE PROVIDER NUMBER
302215038OTHERILLINOISBLUE CROSS BLUE SHIELD

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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