Provider Demographics
NPI:1285649087
Name:COAKLEY, KALEE ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KALEE
Middle Name:ANN
Last Name:COAKLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KALEE
Other - Middle Name:ANN
Other - Last Name:COAKLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:233 E ERIE STREET
Mailing Address - Street 2:SUITE 406
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-587-0200
Mailing Address - Fax:312-587-0223
Practice Address - Street 1:233 E ERIE ST
Practice Address - Street 2:SITE 406
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2926
Practice Address - Country:US
Practice Address - Phone:312-587-0200
Practice Address - Fax:312-587-0223
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3190142311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364414790OtherTAX I.D.