Provider Demographics
NPI:1063495059
Name:TOLOD, ISIDRO S (MD)
Entity Type:Individual
Prefix:
First Name:ISIDRO
Middle Name:S
Last Name:TOLOD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 952100
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-2100
Mailing Address - Country:US
Mailing Address - Phone:314-821-8055
Mailing Address - Fax:314-821-1833
Practice Address - Street 1:1 SAINT ANTHONYS WAY
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4568
Practice Address - Country:US
Practice Address - Phone:618-465-4511
Practice Address - Fax:618-474-6018
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL45454OtherGHP
IL166253OtherHEALTHLINK
IL4503813OtherAETNA
ILC44676OtherMERCY
IL166253OtherHEALTHLINK
IL45454OtherGHP