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Organization

CHAD TATTINI, MD LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. NICHOLE BARNETT (PRACTICE MANAGER)
(309) 664-1007
Entity
Organization

Contact information

Practice address
2502 C EMPIRE STREET, BLOOMINGTON, IL 61704
(309) 664-1007
(309) 664-5006
Mailing address
2502-C EMPIRE STREET, BLOOMINGTON, IL 61704
(309) 664-1007
(309) 664-5006

Taxonomy

Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
036110975
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036110975
IL
01
094439
HEALTH ALLIANCE
IL
01
5732052
BLUE CROSS BLUE SHIELD
IL
01
681561
HEALTH LINK
IL
01
P00169439
RAILROAD MEDICARE
IL
Enumeration date
09/19/2007
Last updated
07/16/2013
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