Provider Demographics
NPI:1710989777
Name:FILIPOWICZ, ROMAN O (MD)
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:O
Last Name:FILIPOWICZ
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 1690
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46352-1690
Mailing Address - Country:US
Mailing Address - Phone:219-326-2312
Mailing Address - Fax:219-326-2584
Practice Address - Street 1:3777 FRONTAGE RD
Practice Address - Street 2:SUITE 400
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7695
Practice Address - Country:US
Practice Address - Phone:219-325-3679
Practice Address - Fax:219-325-3758
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2016-03-01
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
IN01033345207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100164000AMedicaid
IN000000612803OtherANTHEM, BCBS
INB29053Medicare UPIN
IN151020GGGGMedicare PIN
IN100164000AMedicaid