Provider Demographics
NPI:1619969912
Name:ROMMELMAN, MONTE E (MD)
Entity Type:Individual
Prefix:
First Name:MONTE
Middle Name:E
Last Name:ROMMELMAN
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:PO BOX 7038
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-7038
Mailing Address - Country:US
Mailing Address - Phone:270-443-9352
Mailing Address - Fax:270-443-9013
Practice Address - Street 1:5150 VILLAGE SQUARE DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-9060
Practice Address - Country:US
Practice Address - Phone:270-443-9352
Practice Address - Fax:270-443-9013
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28897208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000107264OtherBCBS
KY64288970Medicaid
KY5374554OtherAETNA
KY283363OtherHEALTHLINK
KY250011583Medicare ID - Type UnspecifiedRAILROAD MEDICARE
KY64288970Medicaid
KY1838102Medicare PIN