Provider Demographics
NPI:1316990468
Name:TONKOVIC, RUSS J (MD)
Entity type:Individual
Prefix:
First Name:RUSS
Middle Name:J
Last Name:TONKOVIC
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 1:1555 BARRINGTON RD STE 3200
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-5035
Mailing Address - Country:US
Mailing Address - Phone:847-882-8448
Mailing Address - Fax:
Practice Address - Street 1:1555 BARRINGTON RD
Practice Address - Street 2:DOB 3 SUITE 3200
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1019
Practice Address - Country:US
Practice Address - Phone:847-882-8448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-070718207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00137229OtherRAILROAD MEDICARE
IL036070718Medicaid
P00137229OtherRAILROAD MEDICARE
C43779Medicare UPIN
ILK08744Medicare ID - Type UnspecifiedLOC 15
ILK08746Medicare ID - Type UnspecifiedLOC 16