Provider Demographics
NPI:1760442271
Name:ROMAN, WILLIAM P (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:P
Last Name:ROMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:2308 N ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2773
Mailing Address - Country:US
Mailing Address - Phone:219-464-9588
Mailing Address - Fax:219-462-4470
Practice Address - Street 1:1001 STURDY RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4126
Practice Address - Country:US
Practice Address - Phone:219-462-7173
Practice Address - Fax:219-462-7504
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001033A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN07001033AOtherLICENSE
IN07001033BOtherCSR
P00399960OtherPALMETTO GBA
V05128Medicare UPIN