Healthcare Provider Details

I. General information

NPI: 1891988564
Provider Name (Legal Business Name): CANSLER HEALTH ASSO., S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 08/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E 15TH ST SUITE 306
CHICAGO HEIGHTS IL
60411-3459
US

IV. Provider business mailing address

30 E 15TH ST SUITE 306
CHICAGO HEIGHTS IL
60411-3459
US

V. Phone/Fax

Practice location:
  • Phone: 708-755-3300
  • Fax:
Mailing address:
  • Phone: 708-755-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number036066127
License Number StateIL

VIII. Authorized Official

Name: DR. GAIL D.H. CANSLER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 709-755-3300