Organization
LASER VEIN INSTITUTE SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINIC J TOLITANO MD (PRESIDENT / OWNER)
(630) 860-0035
Entity
Organization
Contact information
Practice address
311 N WALNUT AVE, SUITE 100, WOOD DALE, IL 60191-1566
(630) 860-0035
(630) 860-5262
Mailing address
777 OAKMONT LN, SUITE 1600, WESTMONT, IL 60559-5511
(630) 789-2550
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2232802
BCBS PROVIDER ID
IL
01
—
DG2072
RAILROAD MEDICARE
IL
Enumeration date
10/12/2006
Last updated
02/14/2008
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