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General NPI Number Information
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NPI Number | 1396731063
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Entity Type | Individual
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Provider Name | MICHAEL D TARANTINO MD
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Gender | Male
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 07/30/2021
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Provider Practice Location Address
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Address Line | 427 W NORTHMOOR RD
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City | PEORIA
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State | IL
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Zip | 61614-3542
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Country | US
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Telephone | 309-692-5337
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Fax | 309-693-3913
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Provider Business Mailing Address
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Address Line | 427 W NORTHMOOR RD
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City | PEORIA
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State | IL
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Zip | 61614-3542
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Country | US
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Telephone | 309-692-5337
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Fax | 309-693-3913
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0207X
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Taxonomy Name | Pediatric Hematology & Oncology Physician
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License Number | 29978
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 2080P0207X
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Taxonomy Name | Pediatric Hematology & Oncology Physician
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License Number | 036-101239
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License Number State | IL
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