Provider Demographics
NPI:1558346783
Name:MICLAT, ROMEO SAPURIADA (MD)
Entity type:Individual
Prefix:DR
First Name:ROMEO
Middle Name:SAPURIADA
Last Name:MICLAT
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 1:1060 N ABBE RD
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-1614
Mailing Address - Country:US
Mailing Address - Phone:440-366-6215
Mailing Address - Fax:440-366-6033
Practice Address - Street 1:1060 N ABBE RD
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-1614
Practice Address - Country:US
Practice Address - Phone:440-366-6215
Practice Address - Fax:440-366-6033
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-038553207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2079656Medicaid
OHMI0432602OtherMEDICARE INDIVIDUAL PCAN
OH791111126OtherRAILROAD MEDICARE
OH9295781Medicare PIN
OH791111126OtherRAILROAD MEDICARE