Provider Demographics
NPI:1922054519
Name:STAROMANA, ISMAEL R (MD)
Entity Type:Individual
Prefix:
First Name:ISMAEL
Middle Name:R
Last Name:STAROMANA
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 1:3734 7TH AVE
Mailing Address - Street 2:DOMINICAN BUILDING #15
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-5525
Mailing Address - Country:US
Mailing Address - Phone:262-658-3706
Mailing Address - Fax:262-658-1751
Practice Address - Street 1:3734 7TH AVE
Practice Address - Street 2:DOMINICAN BUILDING #15
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-5525
Practice Address - Country:US
Practice Address - Phone:262-658-3706
Practice Address - Fax:262-658-1751
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25033207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30447800Medicaid
WI30447800Medicaid
WI000032237Medicare PIN