Provider Demographics
NPI:1215270178
Name:CRUZ, CELESTE GERALDINA (MD)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:GERALDINA
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1656 N SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4620
Mailing Address - Country:US
Mailing Address - Phone:773-595-5815
Mailing Address - Fax:
Practice Address - Street 1:3000 N HALSTED ST STE 509
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5194
Practice Address - Country:US
Practice Address - Phone:773-296-3390
Practice Address - Fax:773-296-7531
Is Sole Proprietor?:No
Enumeration Date:2013-03-29
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.145026208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery