Provider Demographics
NPI:1417037714
Name:ROBERT R ROMAN MD PC
Entity Type:Organization
Organization Name:ROBERT R ROMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-855-4144
Mailing Address - Street 1:33200 W 14 MILE RD
Mailing Address - Street 2:STE 130
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3549
Mailing Address - Country:US
Mailing Address - Phone:248-855-4144
Mailing Address - Fax:248-855-9158
Practice Address - Street 1:33200 W 14 MILE RD
Practice Address - Street 2:STE 130
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3549
Practice Address - Country:US
Practice Address - Phone:248-855-4144
Practice Address - Fax:248-855-9158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG03821OtherBLUE CARE NETWORK