Provider Demographics
NPI:1306800545
Name:ALLOCCO, DOMINIC J (MD)
Entity type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:J
Last Name:ALLOCCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19001 OLD LAGRANGE RD
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8012
Mailing Address - Country:US
Mailing Address - Phone:708-478-3600
Mailing Address - Fax:708-478-3552
Practice Address - Street 1:19001 OLD LAGRANGE RD
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8012
Practice Address - Country:US
Practice Address - Phone:708-478-4224
Practice Address - Fax:708-478-4033
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036041838207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621208OtherBLUECROSS BLUE SHIELD
IL036041838Medicaid
IL060053554OtherRAILROAD MEDICARE WILL
IL1508810086OtherGROUP NPI
IL236551OtherMEDICARE GROUP
IL060042334OtherRAILROAD MEDICARE COOK
ILCN2703OtherRAILROAD MEDICARE GROUP PTAN NUMBER
ILCD8033OtherRAILROAD MEDICARE GROUPT PTAN
IL236550OtherMEDICARE GROUP
IL060053554OtherRAILROAD MEDICARE WILL
IL236551OtherMEDICARE GROUP
ILL66277Medicare ID - Type Unspecified