Organization
MICHAEL D. TARANTINO, M.D. S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL D. TARANTINO M.D. (MEDICAL DIRECTOR)
(309) 370-6124
Entity
Organization
Contact information
Practice address
427 W NORTHMOOR RD, PEORIA, IL 61614-3542
(309) 692-5337
(309) 693-3913
Mailing address
2 OLD FARM LN, WASHINGTON, IL 61571-9733
(309) 370-6124
(309) 693-3913
Taxonomy
Speciality
Code
Description
License number
State
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
398680716
—
IL
01
—
7225372
BCBS OF IL
IL
01
—
P00096725
RAILROAD MEDICARE
—
Enumeration date
09/26/2008
Last updated
07/15/2022
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