Individual
KENT S. TAULBEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
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
207N00000X
Dermatology Physician
—
IL
207NS0135X
Procedural Dermatology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5700247
BLUE CROSS BLUE SHIELD
IL
Enumeration date
07/29/2005
Last updated
01/17/2008
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