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General NPI Number Information
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NPI Number | 1316071640
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Entity Type | Individual
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Provider Name | DEEPTI M TOLIA D.O.
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Gender | Female
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6374 N LINCOLN AVE SUITE 203
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City | CHICAGO
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State | IL
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Zip | 60659-1275
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Country | US
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Telephone | 773-509-0023
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Fax | 773-509-1839
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Provider Business Mailing Address
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Address Line | 1441 W WRIGHTWOOD AVE UNIT A
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City | CHICAGO
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State | IL
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Zip | 60614-1121
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Country | US
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Telephone | 630-728-2477
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | IL
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