Healthcare Provider Details

I. General information

NPI: 1992721005
Provider Name (Legal Business Name): DR. CHAD TATTINI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 E EMPIRE ST SUITE C
BLOOMINGTON IL
61704-3738
US

IV. Provider business mailing address

2502 E EMPIRE ST SUITE C
BLOOMINGTON IL
61704-3738
US

V. Phone/Fax

Practice location:
  • Phone: 309-664-1007
  • Fax: 309-664-5006
Mailing address:
  • Phone: 309-664-1007
  • Fax: 309-664-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: