Provider Demographics
NPI:1811959992
Name:TOLITANO, DOMINIC J (MD)
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:J
Last Name:TOLITANO
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 1:777 OAKMONT LN
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5511
Mailing Address - Country:US
Mailing Address - Phone:630-789-2550
Mailing Address - Fax:
Practice Address - Street 1:311 N WALNUT AVE
Practice Address - Street 2:STE 100
Practice Address - City:WOOD DALE
Practice Address - State:IL
Practice Address - Zip Code:60191
Practice Address - Country:US
Practice Address - Phone:630-860-0035
Practice Address - Fax:630-860-5262
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360673282086S0129X, 208G00000X
IN01063986A208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2232802OtherBCBS PROVIDER ID
IL036067328Medicaid
IL02233112OtherBCBS PROVIDER ID
IL780000579OtherRAILROAD MEDICARE
ILP00118649OtherRAILROAD MEDICARE
ILP00460001OtherRAIL ROAD MEDICARE
IL036067328Medicaid
IL02233112OtherBCBS PROVIDER ID
ILK34385Medicare PIN
ILP00460001OtherRAIL ROAD MEDICARE
ILP00118649OtherRAILROAD MEDICARE
ILK34965Medicare PIN
IL780000579Medicare PIN
IL709900Medicare PIN
ILP00118649Medicare PIN