Organization
SOUTHERN COOK RADIATION ONCOLOGY LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORIO M TOLENTINO JR. MD (OFFICER)
(708) 396-0910
Entity
Organization
Contact information
Practice address
2310 YORK ST, SUITE M, BLUE ISLAND, IL 60406-2411
(708) 396-0910
(708) 388-4354
Mailing address
PO BOX 379, ORLAND PARK, IL 60462-0379
(708) 460-9836
(708) 460-1117
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1617459
BCBS IL GR #
IL
01
—
CL9637
RR MEDICARE GR
—
Enumeration date
11/08/2005
Last updated
07/23/2010
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