1811959992 NPI number — DOMINIC J TOLITANO MD

Table of content: DOMINIC J TOLITANO MD (NPI 1811959992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811959992 NPI number — DOMINIC J TOLITANO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOLITANO
Provider First Name:
DOMINIC
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811959992
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
777 OAKMONT LN
Provider Second Line Business Mailing Address:
SUITE 1600
Provider Business Mailing Address City Name:
WESTMONT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60559-5511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-789-2550
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 N WALNUT AVE
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
WOOD DALE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-860-0035
Provider Business Practice Location Address Fax Number:
630-860-5262
Provider Enumeration Date:
04/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  036067328 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X , with the licence number: 01063986A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X , with the licence number: 036067328 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2232802 . This is a "BCBS PROVIDER ID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036067328 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02233112 . This is a "BCBS PROVIDER ID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 780000579 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00118649 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00460001 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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