Provider Demographics
NPI:1679859755
Name:MEMIJE, ROMEO RODRIGUEZ SR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMEO
Middle Name:RODRIGUEZ
Last Name:MEMIJE
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 ASTOR AVE
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181
Mailing Address - Country:US
Mailing Address - Phone:630-889-9251
Mailing Address - Fax:
Practice Address - Street 1:1610 ASTOR AVE
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181
Practice Address - Country:US
Practice Address - Phone:630-889-9251
Practice Address - Fax:630-889-9251
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036043656207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine