Provider Demographics
NPI:1144208554
Name:ROMANELLI, ROBERT J (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:ROMANELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:900 TECHNOLOGY WAY
Mailing Address - Street 2:SUITE 230
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5364
Mailing Address - Country:US
Mailing Address - Phone:847-548-8269
Mailing Address - Fax:847-548-8969
Practice Address - Street 1:900 TECHNOLOGY WAY
Practice Address - Street 2:SUITE 230
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5364
Practice Address - Country:US
Practice Address - Phone:847-548-8269
Practice Address - Fax:847-548-8969
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036095667207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095667Medicaid
G53569Medicare UPIN
ILL58364Medicare ID - Type Unspecified