Provider Demographics
NPI:1740287556
Name:ROMMEREIM-MADDEN, DAPHNE KAE (MD)
Entity type:Individual
Prefix:DR
First Name:DAPHNE
Middle Name:KAE
Last Name:ROMMEREIM-MADDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5623 19TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2901
Mailing Address - Country:US
Mailing Address - Phone:970-810-9011
Mailing Address - Fax:970-810-9135
Practice Address - Street 1:5623 19TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2901
Practice Address - Country:US
Practice Address - Phone:970-810-9011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35637207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1356377Medicaid
COG34717Medicare UPIN
CO1356377Medicaid