Provider Demographics
NPI:1245347749
Name:ROMANKO, MICHAEL JOHN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:ROMANKO
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 1:3560 DELAWARE ST
Mailing Address - Street 2:SUITE 601-A
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3067
Mailing Address - Country:US
Mailing Address - Phone:800-258-2016
Mailing Address - Fax:409-924-9696
Practice Address - Street 1:18300 ST. JOHN DRIVE
Practice Address - Street 2:
Practice Address - City:NASSAU BAY
Practice Address - State:TX
Practice Address - Zip Code:77058-6302
Practice Address - Country:US
Practice Address - Phone:281-333-8822
Practice Address - Fax:281-333-8857
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7116207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82671BOtherBLUE CROSS/BLUE SHIELD
TX3718667OtherCIGNA
TX4229658OtherAETNA
TX82671BOtherBLUE CROSS/BLUE SHIELD
TXC21259Medicare UPIN