Healthcare Provider Details

I. General information

NPI: 1487447587
Provider Name (Legal Business Name): EVERARDO TAFOLLA III DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 N RUTLEDGE ST FL 3
SPRINGFIELD IL
62702-4968
US

IV. Provider business mailing address

PO BOX 19643
SPRINGFIELD IL
62794-9643
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-545-4282
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number125087935
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: