Healthcare Provider Details

I. General information

NPI: 1316071640
Provider Name (Legal Business Name): DEEPTI M TOLIA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6374 N LINCOLN AVE SUITE 203
CHICAGO IL
60659-1275
US

IV. Provider business mailing address

1441 W WRIGHTWOOD AVE UNIT A
CHICAGO IL
60614-1121
US

V. Phone/Fax

Practice location:
  • Phone: 773-509-0023
  • Fax: 773-509-1839
Mailing address:
  • Phone: 630-728-2477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: