Healthcare Provider Details

I. General information

NPI: 1457325060
Provider Name (Legal Business Name): CANER R CELEBOGLU M.D.,F.A.C.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 01/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 SIXTH ST
STREATOR IL
61364
US

IV. Provider business mailing address

104 SIXTH ST PO BOX 828
STREATOR IL
61364
US

V. Phone/Fax

Practice location:
  • Phone: 815-673-5533
  • Fax: 815-673-2554
Mailing address:
  • Phone: 815-673-5533
  • Fax: 815-673-2554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036058159
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: