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Individual

DR. MICHAEL D TARANTINO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

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
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
036-101239
IL
2080P0207X
Pediatric Hematology & Oncology Physician
29978
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
64299787
KENTUCKY MEDICAID
KY
01
7225372
BCBS OF IL
IL
01
P00096725
RAILROAD MEDICARE
Enumeration date
09/27/2005
Last updated
07/30/2021
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