Provider Demographics
NPI:1336120807
Name:TOLENTINO, GREGORIO M JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORIO
Middle Name:M
Last Name:TOLENTINO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 967
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-0967
Mailing Address - Country:US
Mailing Address - Phone:708-396-0909
Mailing Address - Fax:708-388-4354
Practice Address - Street 1:2310 YORK ST
Practice Address - Street 2:SUITE M
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2411
Practice Address - Country:US
Practice Address - Phone:708-396-0910
Practice Address - Fax:708-388-4354
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360535082085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL920000793OtherRR MEDICARE
IL036053508Medicaid
ILK16771Medicare PIN