Provider Demographics
NPI:1780653808
Name:LO, ROMEO CIRIACO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMEO
Middle Name:CIRIACO
Last Name:LO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1672 S 9 ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53005
Mailing Address - Country:US
Mailing Address - Phone:414-383-4700
Mailing Address - Fax:414-383-4759
Practice Address - Street 1:1672 S 9 ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53005
Practice Address - Country:US
Practice Address - Phone:414-383-4700
Practice Address - Fax:414-383-4759
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI20551207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30905700Medicaid
WI73818Medicare ID - Type Unspecified
WI30905700Medicaid