Provider Demographics
NPI:1669680112
Name:CANER CELEBOGLU MD SC
Entity Type:Organization
Organization Name:CANER CELEBOGLU MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CANER
Authorized Official - Middle Name:
Authorized Official - Last Name:CELEBOGLU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-673-5533
Mailing Address - Street 1:104 W 6TH ST
Mailing Address - Street 2:STE 204
Mailing Address - City:STREATOR
Mailing Address - State:IL
Mailing Address - Zip Code:61364-2899
Mailing Address - Country:US
Mailing Address - Phone:815-673-5533
Mailing Address - Fax:815-673-2554
Practice Address - Street 1:104 W 6TH ST
Practice Address - Street 2:STE 204
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364-2899
Practice Address - Country:US
Practice Address - Phone:815-673-5533
Practice Address - Fax:815-673-2554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036058159174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC43700Medicare UPIN