Provider Demographics
NPI:1821072760
Name:ROMINGER, DERIN S (MD)
Entity Type:Individual
Prefix:DR
First Name:DERIN
Middle Name:S
Last Name:ROMINGER
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:ONE MEMORIAL DR
Mailing Address - Street 2:SUITE 216
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-6322
Mailing Address - Country:US
Mailing Address - Phone:217-875-5574
Mailing Address - Fax:217-875-5724
Practice Address - Street 1:ONE MEMORIAL DR
Practice Address - Street 2:SUITE 216
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6322
Practice Address - Country:US
Practice Address - Phone:217-875-5574
Practice Address - Fax:217-875-5724
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086221207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086221Medicaid
IL036086221Medicaid
358960Medicare ID - Type Unspecified