MEDICARE: DR. GREGORIO M TOLENTINO JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	036053508	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	920000793	OTHER	IL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336120807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORIO M TOLENTINO JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 967
Second Line	:
City	:	TINLEY PARK
State	:	IL
Zip	:	60477-0967
Country	:	US
Telephone Number	:	708-396-0909
Fax Number	:	708-388-4354

Provider Business Practice Location Address
First Line	:	2310 YORK ST
Second Line	:	SUITE M
City	:	BLUE ISLAND
State	:	IL
Zip	:	60406-2411
Country	:	US
Telephone Number	:	708-396-0910
Fax Number	:	708-388-4354

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	06/05/2018

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