Healthcare Provider Details

I. General information

NPI: 1891568770
Provider Name (Legal Business Name): JADA COBB MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N 8TH ST FL 3
SPRINGFIELD IL
62701-1041
US

IV. Provider business mailing address

PO BOX 19700
SPRINGFIELD IL
62794-9700
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-545-2321
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-545-2321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number125088386
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: