Provider Demographics
NPI:1619906773
Name:AQUINO, ROMMEL (MD)
Entity Type:Individual
Prefix:
First Name:ROMMEL
Middle Name:
Last Name:AQUINO
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 1:3495 S CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-1455
Mailing Address - Country:US
Mailing Address - Phone:810-424-2011
Mailing Address - Fax:810-249-4037
Practice Address - Street 1:6175 LAPEER RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-2417
Practice Address - Country:US
Practice Address - Phone:810-743-1408
Practice Address - Fax:810-743-1561
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079850207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4666308Medicaid
MIG76490Medicare UPIN
MIM23560129Medicare PIN