Healthcare Provider Details

I. General information

NPI: 1285649087
Provider Name (Legal Business Name): KALEE ANN COAKLEY D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KALEE ANN COAKLEY D.D.S.

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 10/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E ERIE ST SITE 406
CHICAGO IL
60611-2926
US

IV. Provider business mailing address

233 E ERIE STREET SUITE 406
CHICAGO IL
60611
US

V. Phone/Fax

Practice location:
  • Phone: 312-587-0200
  • Fax: 312-587-0223
Mailing address:
  • Phone: 312-587-0200
  • Fax: 312-587-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number319014231
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: