Healthcare Provider Details

I. General information

NPI: 1053057190
Provider Name (Legal Business Name): KADE HADLEY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

581 S 1020 W
AMERICAN FORK UT
84003-4453
US

IV. Provider business mailing address

581 S 1020 W
AMERICAN FORK UT
84003-4453
US

V. Phone/Fax

Practice location:
  • Phone: 786-872-3995
  • Fax:
Mailing address:
  • Phone: 801-607-1007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number19.001181
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: