Provider Demographics
NPI:1982643102
Name:ROM, MICHAEL ELIYAHU (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ELIYAHU
Last Name:ROM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:13170 RAVENNA ROAD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024
Mailing Address - Country:US
Mailing Address - Phone:440-286-1188
Mailing Address - Fax:440-286-1221
Practice Address - Street 1:13170 RAVENNA ROAD
Practice Address - Street 2:SUITE 204
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024
Practice Address - Country:US
Practice Address - Phone:440-286-1188
Practice Address - Fax:440-286-1221
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35061162207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0827761Medicare ID - Type Unspecified
D93603Medicare UPIN
RO0697973Medicare ID - Type Unspecified