Organization
BLOOMINGTON NORMAL EAR NOSE THROAT LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANN KLIMKEWICZ (OFFICE MANAGER)
(309) 662-3277
Entity
Organization
Contact information
Practice address
1404 EASTLAND DR STE 209, BLOOMINGTON, IL 61701-7904
(306) 662-3277
(309) 663-0845
Mailing address
1404 EASTLAND DR STE 209, BLOOMINGTON, IL 61701-7904
(306) 662-3277
(309) 663-0845
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
—
—
207Y00000X
Otolaryngology Physician
Primary
—
—
231H00000X
Audiologist
—
—
237600000X
Audiologist-Hearing Aid Fitter
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05700224
BLUE CROSS/BLUE SHIELD
—
01
—
05732023
BC/BS AUDIOLOGY
—
01
—
330606647-001
AUDIOLOGY
IL
Enumeration date
08/31/2006
Last updated
04/20/2008
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