{"npi":"1396705489","type":"NPI-1","status":"active","name":{"display":"Glen Coulomb MD","other":[],"first":"GLEN","last":"COULOMB","credential":"MD"},"specialty":{"primary_taxonomy":"2086S0129X","primary_taxonomy_description":"Vascular Surgery Physician","slug":"vascular-surgery-physician","schema_org_specialty":null,"all":[{"code":"2086S0129X","description":"Vascular Surgery Physician","primary":true,"state":"IL","license":"036063012"}]},"addresses":[{"purpose":"LOCATION","street_1":"801 S WASHINGTON ST","city":"NAPERVILLE","state":"IL","postal_code":"605407430","country_code":"US","phone":"6302812670","fax":"8153272475"},{"purpose":"MAILING","street_1":"1919 S HIGHLAND AVE","city":"LOMBARD","state":"IL","postal_code":"601486153","country_code":"US","street_2":"STE B202","phone":"6308737305","fax":"6304163189"}],"license":{"state":"IL","number":"036063012"},"identifiers":[{"type_code":"01","label":"Other","value":"02215038","state":"IL","issuer":"BLUE CROSS BLUE SHIELD"}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20051017000751","type_code":"14-08","type_desc":"PRACTITIONER - FAMILY PRACTICE","state":"IL","pac_id":"3971529231"}]},"enumeration_date":"2006-03-24","last_updated":"2011-02-22","_meta":{"source":"NPPES","snapshot_date":"2011-02-22","doc_url":"https://findmynpi.com/api"}}