Healthcare Provider Details

I. General information

NPI: 1588691877
Provider Name (Legal Business Name): JOSEPH J SARMIENTO III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5405 NORTH KNOXVILLE AVENUE
PEORIA IL
61614
US

IV. Provider business mailing address

5405 NORTH KNOXVILLE AVENUE
PEORIA IL
61614
US

V. Phone/Fax

Practice location:
  • Phone: 309-691-4410
  • Fax: 309-589-2830
Mailing address:
  • Phone: 309-691-4410
  • Fax: 309-589-2830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036070719
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number036-070719
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: