Provider Demographics
NPI:1114918547
Name:PROSKE, ANTHONY E (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:E
Last Name:PROSKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 379
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-0379
Mailing Address - Country:US
Mailing Address - Phone:708-460-9836
Mailing Address - Fax:708-460-1117
Practice Address - Street 1:2132 W JEFFERSON ST
Practice Address - Street 2:SUITE A
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6622
Practice Address - Country:US
Practice Address - Phone:815-744-7762
Practice Address - Fax:815-744-7861
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360475412084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1235120668OtherCORP NPI#
IL09900406OtherBCBS IL
IL036047541Medicaid
IL09900406OtherBCBS IL