Healthcare Provider Details

I. General information

NPI: 1700460003
Provider Name (Legal Business Name): KADI LEE COOLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 N RUTLEDGE ST FL 3
SPRINGFIELD IL
62702-6700
US

IV. Provider business mailing address

PO BOX 19638
SPRINGFIELD IL
62794-9638
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-545-7789
Mailing address:
  • Phone: 217-545-7789
  • Fax: 217-545-8000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number125.088422
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: