Provider Demographics
NPI:1841489770
Name:ROMEO MEDICAL , PLLC
Entity type:Organization
Organization Name:ROMEO MEDICAL , PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MPHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:JAAMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-752-9694
Mailing Address - Street 1:241 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROMEO
Mailing Address - State:MI
Mailing Address - Zip Code:48065-4619
Mailing Address - Country:US
Mailing Address - Phone:586-752-9694
Mailing Address - Fax:586-752-7871
Practice Address - Street 1:241 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROMEO
Practice Address - State:MI
Practice Address - Zip Code:48065-4619
Practice Address - Country:US
Practice Address - Phone:586-752-9694
Practice Address - Fax:586-752-7871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070853173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N57530Medicare PIN
MIH59544Medicare UPIN