Healthcare Provider Details

I. General information

NPI: 1740430784
Provider Name (Legal Business Name): MICHAEL D. TARANTINO, M.D. S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 W NORTHMOOR RD
PEORIA IL
61614-3542
US

IV. Provider business mailing address

2 OLD FARM LN
WASHINGTON IL
61571-9733
US

V. Phone/Fax

Practice location:
  • Phone: 309-692-5337
  • Fax: 309-693-3913
Mailing address:
  • Phone: 309-370-6124
  • Fax: 309-693-3913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL D. TARANTINO
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 309-370-6124