Provider Demographics
NPI:1235120668
Name:ANTHONY PROSKE MD LTD
Entity Type:Organization
Organization Name:ANTHONY PROSKE MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:PROSKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-774-2970
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:708-774-2970
Mailing Address - Fax:708-460-1117
Practice Address - Street 1:300 BARNEY DR
Practice Address - Street 2:SUITE C
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5296
Practice Address - Country:US
Practice Address - Phone:815-744-7762
Practice Address - Fax:815-744-7861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9900406OtherBCBS IL GR#
IL590450Medicare ID - Type Unspecified