Provider Demographics
NPI:1417999004
Name:ALEXANDER A ROMASHKO MD SC
Entity Type:Organization
Organization Name:ALEXANDER A ROMASHKO MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROMASHKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-522-4890
Mailing Address - Street 1:2607 N GRANDVIEW BLVD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1686
Mailing Address - Country:US
Mailing Address - Phone:262-522-4890
Mailing Address - Fax:877-259-2359
Practice Address - Street 1:2607 N GRANDVIEW BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1686
Practice Address - Country:US
Practice Address - Phone:262-522-4890
Practice Address - Fax:877-259-2359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47616207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34663200Medicaid
I37778Medicare UPIN
WI000001491Medicare PIN