Healthcare Provider Details

I. General information

NPI: 1376570341
Provider Name (Legal Business Name): THOMAS P FIERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E WASHINGTON ST
BLOOMINGTON IL
61701-4364
US

IV. Provider business mailing address

P O BOX 960214
OKLAHOMA CITY OK
73196-0001
US

V. Phone/Fax

Practice location:
  • Phone: 309-662-3311
  • Fax:
Mailing address:
  • Phone: 877-485-4474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036112876
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: