Provider Demographics
NPI:1598951063
Name:CHAD TATTINI, MD LLC
Entity Type:Organization
Organization Name:CHAD TATTINI, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-664-1007
Mailing Address - Street 1:2502-C EMPIRE STREET
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704
Mailing Address - Country:US
Mailing Address - Phone:309-664-1007
Mailing Address - Fax:309-664-5006
Practice Address - Street 1:2502 C EMPIRE STREET
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704
Practice Address - Country:US
Practice Address - Phone:309-664-1007
Practice Address - Fax:309-664-5006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110975261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL094439OtherHEALTH ALLIANCE
IL5732052OtherBLUE CROSS BLUE SHIELD
IL036110975Medicaid
ILP00169439OtherRAILROAD MEDICARE
IL681561OtherHEALTH LINK
ILI01818Medicare UPIN
IL094439OtherHEALTH ALLIANCE