Provider Demographics
NPI:1396206801
Name:MAGID, ROMAN (DO)
Entity Type:Individual
Prefix:DR
First Name:ROMAN
Middle Name:
Last Name:MAGID
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 A AVE NE STE 105
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5060
Mailing Address - Country:US
Mailing Address - Phone:319-368-5992
Mailing Address - Fax:
Practice Address - Street 1:855 A AVE NE STE 105
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5060
Practice Address - Country:US
Practice Address - Phone:319-368-5992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2023-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125073897208100000X
IADO-06351208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation