Provider Demographics
NPI:1245432368
Name:ROMERO ROMERO, VIVIAN CAROLINA (MD)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:CAROLINA
Last Name:ROMERO ROMERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-486-6790
Mailing Address - Fax:616-486-6702
Practice Address - Street 1:25 MICHIGAN ST NE
Practice Address - Street 2:SUITE 5200
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2515
Practice Address - Country:US
Practice Address - Phone:616-391-3681
Practice Address - Fax:616-391-8670
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2021-02-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301086388207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM74460719Medicare PIN