Organization
THE BLEEDING AND CLOTTING DISORDERS INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL D 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
261Q00000X
Clinic/Center
Primary
036101239
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
398680716
—
IL
01
—
7225372
BCBS OF IL
—
Enumeration date
01/14/2011
Last updated
07/30/2021
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