Provider Demographics
NPI:1164423471
Name:COLE, TONYA ECHOLS (MD)
Entity type:Individual
Prefix:DR
First Name:TONYA
Middle Name:ECHOLS
Last Name:COLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 HARVESTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5965
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 INGALLS DR
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-3558
Practice Address - Country:US
Practice Address - Phone:708-915-6620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA473132085R0001X
IL0361693942085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10068321OtherAMERIGROUP
GA117237OtherPEACHSTATE
GA20-0761381OtherHUMANA MILITARY HEALTHCAR
GA36 00519OtherUNITED HEALTHCARE
GA000835788RMedicaid
GA30 00519OtherUHC
200761381 0005OtherCIGNA HEALTHCARE
GA12557Other1ST MEDICAL NETWORK
GA200761381 30033 A001OtherWPS TRICARE ADMINISTRATIO
GA20-0761381OtherCOVENTRY
GA782373(EMC)OtherBLUE CROSS BLUE SHIELD
GA20-0761381OtherPHCS
GAP00231025OtherRR MEDICARE PALMETTO GBA
GA172201200452OtherHUMANA
GA7488088OtherAETNA US HEALTHCARE
GA20-0761381OtherCOVENTRY
GA12557Other1ST MEDICAL NETWORK