Provider Demographics
NPI:1275977159
Name:ROMERO-SHU, MARCELO ANDRES
Entity Type:Individual
Prefix:DR
First Name:MARCELO
Middle Name:ANDRES
Last Name:ROMERO-SHU
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:S63W13660 JANESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-2713
Mailing Address - Country:US
Mailing Address - Phone:414-425-9393
Mailing Address - Fax:
Practice Address - Street 1:S63W13660 JANESVILLE RD
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-2713
Practice Address - Country:US
Practice Address - Phone:414-425-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI7076-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program