Provider Demographics
NPI:1295714244
Name:ROMANELLI, RONALD R (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:R
Last Name:ROMANELLI
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:PO BOX 9469
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62791-9469
Mailing Address - Country:US
Mailing Address - Phone:217-547-9100
Mailing Address - Fax:217-547-9247
Practice Address - Street 1:1301 S KOKE MILL RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-9252
Practice Address - Country:US
Practice Address - Phone:217-547-9100
Practice Address - Fax:217-547-9247
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2020-06-09
Deactivation Date:2020-04-06
Deactivation Code:
Reactivation Date:2020-06-09
Provider Licenses
StateLicense IDTaxonomies
IL036069839207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036069839Medicaid
IL200026706OtherRR MEDICARE
IL036069839Medicaid
IL1181750001Medicare NSC