Provider Demographics
NPI:1972669463
Name:ROMEO S. MICLAT, M.D., INC
Entity Type:Organization
Organization Name:ROMEO S. MICLAT, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMEO
Authorized Official - Middle Name:S
Authorized Official - Last Name:MICLAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-365-9371
Mailing Address - Street 1:1060 N ABBE ROAD
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035
Mailing Address - Country:US
Mailing Address - Phone:440-365-9371
Mailing Address - Fax:440-366-6033
Practice Address - Street 1:1060 N ABBE ROAD
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035
Practice Address - Country:US
Practice Address - Phone:440-365-9371
Practice Address - Fax:440-366-6033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-038553207R00000X, 207RN0300X
OH35-038552207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000498009OtherANTHEM NEPH
OH2079656Medicaid
OH000000498011OtherANTHEM IM
OH35-038553OtherLICENSE NUMBER
OHCG6814OtherRAILROAD MEDICARE
OHA75813Medicare UPIN
OH2079656Medicaid