Provider Demographics
NPI:1992721005
Name:TATTINI, CHAD
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:
Last Name:TATTINI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 E EMPIRE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-3738
Mailing Address - Country:US
Mailing Address - Phone:309-664-1007
Mailing Address - Fax:309-664-5006
Practice Address - Street 1:2502 E EMPIRE ST
Practice Address - Street 2:SUITE C
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-3738
Practice Address - Country:US
Practice Address - Phone:309-664-1007
Practice Address - Fax:309-664-5006
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL681561OtherHEALTH LINK
ILP00169439OtherRURAL MEDICARE
IL5732052OtherBLUE CROSS BLUE SHIELD
IL094439OtherHEALTH ALLIANCE
IL681561OtherHEALTH LINK
ILP00169439OtherRURAL MEDICARE