MEDICARE: DR. TONY J TOLOCZKO 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	207R00000X	Internal Medicine Physician	43541	CO
2	208000000X	Pediatrics Physician	43541	CO
3	207R00000X	Internal Medicine Physician	2023009164	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	018342	OTHER	CO	KAISER COMMERCIAL MEMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346330925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TONY J TOLOCZKO MD

Provider Business Mailing Address
First Line	:	PO BOX 955534
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-5534
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1035 BELLEVUE AVE STE 400
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63117-1844
Country	:	US
Telephone Number	:	314-925-4700
Fax Number	:

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	03/20/2023

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