Provider Demographics
NPI:1881783199
Name:DOMINIC J TOLITANO, MD SC
Entity type:Organization
Organization Name:DOMINIC J TOLITANO, MD SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:TOLITANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-860-0035
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191
Mailing Address - Country:US
Mailing Address - Phone:630-860-0035
Mailing Address - Fax:630-860-5262
Practice Address - Street 1:311 N. WALNUT AVE
Practice Address - Street 2:SUITE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042617537208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02233112OtherBCBS PROVIDER ID
IL042617537OtherREGISTERED CORP LICENSE
ILDG8754OtherRAIL ROAD MEDICARE
IL780000579OtherRAILROAD MEDICARE
IL214695Medicare PIN
IL214694Medicare PIN
IL042617537OtherREGISTERED CORP LICENSE