Individual
DR. STEVEN DOMIANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2800 W 95TH ST, EVERGREEN, IL 60805
(708) 229-5104
(630) 323-1699
Mailing address
111 OAKWOOD RD, EAST PEORIA, IL 61611-1853
(309) 740-4272
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036084150
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0221524519
BLUE CROSS BLUE SHIELD
—
05
—
036084150
—
IL
01
—
300027345
RRMDH
—
Enumeration date
07/19/2006
Last updated
10/23/2023
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