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Organization
THE BLEEDING AND CLOTTING DISORDERS INSTITUTE
Active
Organization
THE BLEEDING AND CLOTTING DISORDERS INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL TARANTINO M.D. (MEDICAL DIRECTOR)
(309) 692-5337
Entity
Organization
Contact information
Practice address
427 W NORTHMOOR RD, PEORIA, IL 61614-3542
(309) 692-5337
(309) 693-3913
Mailing address
427 W NORTHMOOR RD, PEORIA, IL 61614-3542
(309) 692-5337
(309) 693-3913
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
054-017718
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
398680716
—
IL
01
—
7225372
BCBS OF IL
—
Enumeration date
08/29/2011
Last updated
07/30/2021
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