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General NPI Number Information
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NPI Number | 1891988564
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Entity Type | Organization
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Legal Business Name | CANSLER HEALTH ASSO., S.C.
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Dates
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Enumeration Date | 08/24/2007
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Last Update Date | 08/24/2007
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Provider Practice Location Address
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Address Line | 30 E 15TH ST SUITE 306
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City | CHICAGO HEIGHTS
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State | IL
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Zip | 60411-3459
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Country | US
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Telephone | 708-755-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 30 E 15TH ST SUITE 306
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City | CHICAGO HEIGHTS
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State | IL
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Zip | 60411-3459
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Country | US
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Telephone | 708-755-3300
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GAIL D.H. CANSLER
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Credential | M.D.
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Telephone | 709-755-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 036066127
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License Number State | IL
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