Provider Demographics
NPI:1598872111
Name:COLEMAN, JOY LYNN (MD)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:LYNN
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:701 LEE ST
Mailing Address - Street 2:#300
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4539
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 S MILWAUKEE AVE
Practice Address - Street 2:RADIATION ONCOLOGY DEPARTMENT BUILDING 880
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3204
Practice Address - Country:US
Practice Address - Phone:847-990-5910
Practice Address - Fax:847-573-4250
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1154982085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036115498Medicaid
IL209405002Medicare PIN
IL749641001Medicare PIN
IL749640002Medicare PIN
I58215Medicare UPIN