Provider Demographics
NPI:1477548170
Name:TATOOLES, ANTONE JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONE
Middle Name:JOHN
Last Name:TATOOLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 BORMET DR STE 204
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8399
Mailing Address - Country:US
Mailing Address - Phone:708-346-4044
Mailing Address - Fax:708-346-3287
Practice Address - Street 1:4400 W 95TH ST STE 308
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2660
Practice Address - Country:US
Practice Address - Phone:708-346-4040
Practice Address - Fax:708-346-3287
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089268208600000X, 208G00000X
IN01045251A208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01618941OtherBCBS
MI1477548170Medicaid
IN200123450AMedicaid
IN200123450EMedicaid
IL036089268Medicaid
IN200123450CMedicaid
IN200123450BMedicaid
IN200123450DMedicaid
IL01618941OtherBCBS
IN780002107Medicare PIN
ILG24716Medicare UPIN
IL211578002Medicare PIN
IL53555004Medicare PIN
IN200123450BMedicaid
MI1477548170Medicaid
IL780001787Medicare PIN