Provider Demographics
NPI:1891988564
Name:CANSLER HEALTH ASSO., S.C.
Entity Type:Organization
Organization Name:CANSLER HEALTH ASSO., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:DH
Authorized Official - Last Name:CANSLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:709-755-3300
Mailing Address - Street 1:30 E 15TH ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-3459
Mailing Address - Country:US
Mailing Address - Phone:708-755-3300
Mailing Address - Fax:
Practice Address - Street 1:30 E 15TH ST
Practice Address - Street 2:SUITE 306
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-3459
Practice Address - Country:US
Practice Address - Phone:708-755-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066127261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036066127Medicaid
IL036066127Medicaid