Provider Demographics
NPI:1154646628
Name:COOLING, DANIELLE M (MD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:COOLING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:M
Other - Last Name:SUHAJDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1020 E OGDEN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8609
Mailing Address - Country:US
Mailing Address - Phone:630-369-4550
Mailing Address - Fax:630-369-9762
Practice Address - Street 1:1020 E OGDEN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8609
Practice Address - Country:US
Practice Address - Phone:630-369-4550
Practice Address - Fax:630-369-9762
Is Sole Proprietor?:No
Enumeration Date:2010-03-28
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI57380-20208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1154646628Medicaid
WI322500138Medicare PIN