| The Bleeding And Clotting Disorders Institute | |
|
427 W Northmoor Rd Peoria IL 61614-3542 | |
| (309) 692-5337 | |
| (309) 693-3913 |
| Full Name | The Bleeding And Clotting Disorders Institute |
|---|---|
| Speciality | Clinic/Center |
| Location | 427 W Northmoor Rd, Peoria, Illinois |
| Authorized Official Name and Position | Michael D Tarantino (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3096925337 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Bleeding And Clotting Disorders Institute 427 W Northmoor Rd Peoria IL 61614-3542 Ph: (309) 692-5337 | The Bleeding And Clotting Disorders Institute 427 W Northmoor Rd Peoria IL 61614-3542 Ph: (309) 692-5337 |
| NPI Number | 1134424633 |
|---|---|
| Provider Enumeration Date | 01/14/2011 |
| Last Update Date | 07/30/2021 |
| Medicare PECOS PAC ID | 6608051230 |
|---|---|
| Medicare Enrollment ID | O20110426000500 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134424633 | NPI | - | NPPES |
| 398680716 | Medicaid | IL | |
| 7225372 | Other | BCBS OF IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 036101239 (Illinois) | Primary |
| Provider Name | Michael Dominic Tarantino |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1396731063 PECOS PAC ID: 2668418245 Enrollment ID: I20090205000348 |
| Provider Name | Jonathan C Roberts |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1871757070 PECOS PAC ID: 5193994424 Enrollment ID: I20140730000552 |
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