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Organization

KENT S TAULBEE MD SC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KENT S TAULBEE MD (CEO)
(309) 663-6386
Entity
Organization

Contact information

Practice address
2418 E LINCOLN ST, BLOOMINGTON, IL 61701-5915
(309) 663-6386
(309) 662-7622
Mailing address
2418 E LINCOLN ST, BLOOMINGTON, IL 61701-5915
(309) 663-6386
(309) 662-7622

Taxonomy

Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
5700247
BLUE CROSS BLUE SHIELD
IL
Enumeration date
10/31/2007
Last updated
10/31/2007
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