Provider Demographics
NPI:1316040389
Name:ROMEO, MICHAEL W
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:ROMEO
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 1:1801 COLORADO AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382
Mailing Address - Country:US
Mailing Address - Phone:209-216-3456
Mailing Address - Fax:209-216-3462
Practice Address - Street 1:1801 COLORADO AVE
Practice Address - Street 2:STE 120
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382
Practice Address - Country:US
Practice Address - Phone:209-216-3456
Practice Address - Fax:209-216-3462
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85879207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG85879OtherLIC
CAG85879OtherLIC
CAG85879OtherLIC