Provider Demographics
NPI:1174566350
Name:ROMEO, ORESTE (MD)
Entity type:Individual
Prefix:
First Name:ORESTE
Middle Name:
Last Name:ROMEO
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 1:601 JOHN ST
Mailing Address - Street 2:BOX 67
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-6022
Mailing Address - Fax:269-341-8244
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:BOX 67
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-341-6022
Practice Address - Fax:269-341-8244
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080253208600000X, 2086S0102X
IN01067321A2086S0102X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000768084OtherANTHEM PIN
IN200964850Medicaid
IN000000824111OtherANTHEM PROVIDER NUMBER
INP01271414Medicare PIN
INM400070261Medicare PIN
IN815500026Medicare PIN
MI0D16150148Medicare PIN
IN247920BMedicare PIN
IN000000768084OtherANTHEM PIN
H40631Medicare UPIN