Provider Demographics
NPI:1437114063
Name:ROMANIUK, ALEX GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:GEORGE
Last Name:ROMANIUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 WILLIAM WAY NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312
Mailing Address - Country:US
Mailing Address - Phone:423-478-1050
Mailing Address - Fax:423-478-1075
Practice Address - Street 1:1060 WILLIAM WAY NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4369
Practice Address - Country:US
Practice Address - Phone:423-478-1050
Practice Address - Fax:423-478-1075
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD28833207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3815601Medicaid
TNG52130Medicare UPIN
TN3815601Medicaid