Provider Demographics
NPI:1639109663
Name:VITULLO, DOLORES ANN (MD)
Entity type:Individual
Prefix:
First Name:DOLORES
Middle Name:ANN
Last Name:VITULLO
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 1:155 HARBOR DRIVE
Mailing Address - Street 2:UNIT 1702
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601
Mailing Address - Country:US
Mailing Address - Phone:312-856-0980
Mailing Address - Fax:
Practice Address - Street 1:2300 CHILDRENS PLAZA BOX 21
Practice Address - Street 2:CHILDRENS MEMORIAL HOSPITAL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614
Practice Address - Country:US
Practice Address - Phone:773-880-4553
Practice Address - Fax:773-880-8111
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360477422080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036047742Medicaid
IL036047742Medicaid
ILL88320Medicare ID - Type Unspecified