Healthcare Provider Details

I. General information

NPI: 1235120668
Provider Name (Legal Business Name): ANTHONY PROSKE MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BARNEY DR SUITE C
JOLIET IL
60435-5296
US

IV. Provider business mailing address

PO BOX 379
ORLAND PARK IL
60462-0379
US

V. Phone/Fax

Practice location:
  • Phone: 815-744-7762
  • Fax: 815-744-7861
Mailing address:
  • Phone: 708-774-2970
  • Fax: 708-460-1117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY PROSKE
Title or Position: OFFICER
Credential: MD
Phone: 708-774-2970