Healthcare Provider Details

I. General information

NPI: 1083668313
Provider Name (Legal Business Name): MANDANA TOOLE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 W. CLAREMONT
CHICAGO IL
60622-1791
US

IV. Provider business mailing address

DEPT. 20-DIV001 PO BOX 5940
CAROL STREAM IL
60197-5940
US

V. Phone/Fax

Practice location:
  • Phone: 312-770-2000
  • Fax:
Mailing address:
  • Phone: 630-734-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: