Provider Demographics
NPI:1144205402
Name:ROMAN, ROBERT R (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:ROMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:33200 W 14 MILE RD
Mailing Address - Street 2:STE 130
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3549
Mailing Address - Country:US
Mailing Address - Phone:248-855-4144
Mailing Address - Fax:248-855-9158
Practice Address - Street 1:33200 W 14 MILE RD
Practice Address - Street 2:STE 130
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3549
Practice Address - Country:US
Practice Address - Phone:248-855-4144
Practice Address - Fax:248-855-9158
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301036693208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2115779Medicaid
MI3506316331OtherBLUE CROSS BLUE SHIELD
MIF13738OtherHAP
MIF13738OtherHAP