DR. MICHAEL D TARANTINO (NPI# 1396731063) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396731063 |
| Entity Type | Individual |
| Full Name | DR. MICHAEL D TARANTINO |
| Credential | MD |
| Practice Address |
9128 N Lindbergh Dr Peoria IL 61615-1422 |
| Practice Telephone | 3096925337 |
| Practice Fax Number | 3096933913 |
| Mailing Telephone | 3096925337 |
| Mailing Fax Number | 3096933913 |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2015-08-31 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2080P0207X |
Pediatrics Specialization: Pediatric Hematology-Oncology |
29978 | KY | Allopathic & Osteopathic Physicians |
| Y | 2080P0207X |
Pediatrics Specialization: Pediatric Hematology-Oncology |
036-101239 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RAILROAD MEDICARE | P00096725 | 01 | |
| KY | KENTUCKY MEDICAID | 64299787 | 01 |
| IL | BCBS OF IL | 7225372 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659986602 | Michael Nicholas Tarantino | Speech-Language Pathologist | 2399 Ferrand St Ste H, Monroe, LA 71201-3208 | 2020-09-15 |
| 1750382784 | Michael Jude Tarantino | Surgery | 108 Arbor Ln, New Iberia, LA 70563-2822 | 2005-08-01 |
| Street Address |
9128 N LINDBERGH DR |
| City | PEORIA |
| State | IL |
| Zip Code | 61615-1422 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396396024 | Kristin T Ansteatt | Registered Nurse | 9128 N Lindbergh Dr, Peoria, IL 61615-1422 | 2019-09-24 |
| 1225571219 | Jackie Marie Helms | Nurse Practitioner | 9128 N Lindbergh Dr, Peoria, IL 61615-1422 | 2016-11-23 |
| 1720450026 | Elizabeth Ann Lepper | Nurse Practitioner | 9128 N Lindbergh Dr, Peoria, IL 61615-1422 | 2015-10-26 |
| 1639508567 | The Bleeding and Clotting Disorders Institute | Pharmacy | 9128 N Lindbergh Dr, Peoria, IL 61615-1422 | 2013-11-01 |
| 1639434871 | Stephanie Lynn Arnold | Pharmacist | 9128 N Lindbergh Dr, Peoria, IL 61615-1422 | 2012-07-12 |
| 1962783431 | The Bleeding and Clotting Disorders Institute | Pharmacy | 9128 N Lindbergh Dr, Peoria, IL 61615-1422 | 2011-08-29 |
| 1134424633 | The Bleeding and Clotting Disorders Institute | Clinic/Center | 9128 N Lindbergh Dr, Peoria, IL 61615-1422 | 2011-01-14 |
| 1538469481 | Rohith Jesudas | Pediatrics | 9128 N Lindbergh Dr, Peoria, IL 61615-1422 | 2010-10-26 |
| 1871757070 | Jonathan Charles Roberts | Pediatrics | 9128 N Lindbergh Dr, Peoria, IL 61615-1422 | 2008-07-16 |
| 1366461139 | Amanda Kilgore | Physical Therapist | 9128 N Lindbergh Dr, Peoria, IL 61615 | 2006-07-19 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124627906 | Lance Jay Bucher | Occupational Therapist | 8600 Il-91, Peoria, IL 61615 | 2020-10-22 |
| 1093327496 | Angela Mitchell | Speech-Language Pathologist | 3903 W Ridgeview Dr, Peoria, IL 61615 | 2020-08-18 |
| 1578110680 | Emily E Buenting | Audiologist | 8600 Il Route 91, Suite 300, Peoria, IL 61615 | 2019-08-22 |
| 1730655572 | Sylwia M. Budzik | Physician Assistant | 8600 Illinois Rt. 91, Suite 300, Peoria, IL 61615 | 2018-10-19 |
| 1487169207 | Heather Hart | Registered Nurse | 9016 N. Scrimshaw Dr. Apt 104, Peoria, IL 61615 | 2017-12-04 |
| 1528586849 | Leanne Runyon | Speech-Language Pathologist | 10723 Collett Dr., Peoria, IL 61615 | 2017-09-07 |
| 1467974196 | Elizabeth A Mcleod | Nurse Practitioner | 8600 Illinois Route 91, Suite 130, Peoria, IL 61615 | 2017-07-14 |
| 1790223022 | Janet Warner | Counselor | 8914 North Prarie Court, Peoria, IL 61615 | 2017-02-07 |
| 1437524022 | Brooke Bisping | Dietitian, Registered | 7610 North Orange Prairie Road, Peoria, IL 61615 | 2015-12-08 |
| 1003292111 | Crystal Ann Casper | Dietitian, Registered | 7610 N Orange Prarie Road, Peoria, IL 61615 | 2015-07-31 |
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| Taxonomy Code | 2080P0207X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Hematology-Oncology |
| A pediatrician trained in the combination of pediatrics, hematology and oncology to recognize and manage pediatric blood disorders and cancerous diseases. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265720510 | Reuben Antony | Pediatrics | 530 Ne Glen Oak Ave., C/o Ms Suzy Lewellen, Peoria, IL 61637 | 2011-07-20 |
| 1568433050 | University of Illinois | Pediatrics | St Jude Midwest Affiliate, 530 Ne Glen Oak, Peoria, IL 61637-0001 | 2006-02-01 |
| 1841293032 | Pedro A De Alarcon | Pediatrics | Children's Hospital of Illinois 530 Ne Glen Oak Ave, Peoria, IL 61637 | 2005-05-23 |
| 1205195849 | Brinda Mukesh Mehta | Pediatrics | 530 Ne Glen Oak Ave, Uicomp/dept. of Pediatrics Osf North Bldg. Room 5642, Peoria, IL 61637 | 2012-05-15 |
| 1740430784 | Michael D. Tarantino, M.d. S.c. | Pediatrics | 6811 N Knoxville Ave, Suite A, Peoria, IL 61614-2861 | 2008-09-26 |
| 1558339978 | Kay Saving | Pediatrics | St Jude Midwest Affiliate, 530 Ne Glen Oak, Peoria, IL 61637-0001 | 2006-03-10 |
| 1841287588 | Mary Elizabeth Ross | Pediatrics | 530 Ne Glen Oak Ave, Peoria, IL 61637 | 2005-09-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780829911 | Richard Moldwin | Pediatrics | 9017 Ewing Ave, Evanston, IL 60203-1908 | 2008-12-02 |
| 1801005848 | Marie-ellen Tubal Sarvida | Pediatrics | 4440 West 95th Street, Oak Lawn, IL 60453 | 2007-05-22 |
| 1639395304 | Lenore Evans Gonzalez | Pediatrics | 236 S 5th St, Apt C, Springfield, IL 62701-1431 | 2007-04-18 |
| 1700948643 | Astrid K. Mack | Pediatrics | 2300 N Childrens Plz # 30, Chicago, IL 60614-3363 | 2006-12-15 |
| 1659449163 | Pediatric Cancer Institute | Pediatrics | 4440 W.95th Street, Oak Lawn, IL 60453 | 2006-12-01 |
| 1699724385 | Joanna Lynn Weinstein | Pediatrics | 2300 Childrens Plaza Box 30, Childrens Memorial Hospital Hem Onc, Chicago, IL 60614 | 2006-05-09 |
| 1427051622 | John M Cunningham | Pediatrics | 5841 South Maryland Ave, University of Chicago Rm N-112 Mc 4060, Chicago, IL 60637 | 2005-05-23 |
| 1053958173 | Anna Kathryn Person | Pediatrics | 225 E Chicago Ave, Chicago, IL 60611-2991 | 2019-12-09 |
| 1891189221 | Lindsay Schwartz | Pediatrics | 5841 S Maryland Ave # Mc4060, Chicago, IL 60637-1443 | 2015-03-24 |
| 1639599475 | Katherine Marie Harris | Pediatrics | 5841 S Maryland Ave # Mc4060, Chicago, IL 60637-1443 | 2014-04-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.