Provider Demographics
NPI:1013452168
Name:PROSALUD6238 INC
Entity Type:Organization
Organization Name:PROSALUD6238 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CANELAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-829-7422
Mailing Address - Street 1:6238 CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2319
Mailing Address - Country:US
Mailing Address - Phone:708-795-5020
Mailing Address - Fax:708-795-5158
Practice Address - Street 1:6238 CERMAK RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2319
Practice Address - Country:US
Practice Address - Phone:708-795-5020
Practice Address - Fax:708-795-5158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-28
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085902208000000X
IL0360848002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty