Provider Demographics
NPI:1710341524
Name:ROMAIN, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:ROMAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 W. TAYLOR ST.
Mailing Address - Street 2:CLINIC 2A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4795
Mailing Address - Country:US
Mailing Address - Phone:312-996-1300
Mailing Address - Fax:312-996-8814
Practice Address - Street 1:1801 W. TAYLOR ST.
Practice Address - Street 2:CLINIC 2A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4795
Practice Address - Country:US
Practice Address - Phone:312-996-1300
Practice Address - Fax:312-996-8814
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005769213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist