Provider Demographics
NPI:1891973640
Name:WILLIAM PAUL ROMAN JR
Entity Type:Organization
Organization Name:WILLIAM PAUL ROMAN JR
Other - Org Name:ROMAN FOOT AND ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:219-464-9588
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 1:2308 N ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2773
Practice Address - Country:US
Practice Address - Phone:219-464-9588
Practice Address - Fax:219-462-4470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001033A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200843560AMedicaid
INLICENSEOther07001033A
IL016-005187OtherLICENSE
IN07001033BOtherCONTROLLED SUBSTANCE(CSR)
IN200843560AMedicaid
IL016-005187OtherLICENSE
INLICENSEOther07001033A