Provider Demographics
NPI:1225897135
Name:KEIM, ROMAN A SR
Entity Type:Individual
Prefix:MR
First Name:ROMAN
Middle Name:A
Last Name:KEIM
Suffix:SR
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 1:601 PITTSBURGH AVE STE E
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-3933
Mailing Address - Country:US
Mailing Address - Phone:740-507-9399
Mailing Address - Fax:
Practice Address - Street 1:601 PITTSBURGH AVE STE E
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-3933
Practice Address - Country:US
Practice Address - Phone:740-507-9399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171WH0202X
171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications