Provider Demographics
NPI:1124131198
Name:ROMAN, ARLENE ZOE (MD)
Entity type:Individual
Prefix:DR
First Name:ARLENE
Middle Name:ZOE
Last Name:ROMAN
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 1:808 W LAKE LANSING RD STE 104
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6301
Mailing Address - Country:US
Mailing Address - Phone:517-200-3955
Mailing Address - Fax:
Practice Address - Street 1:808 W LAKE LANSING RD STE 104
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6301
Practice Address - Country:US
Practice Address - Phone:517-200-3955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME911002084P0800X
MI43010516942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001097600Medicaid
FLCP917ZMedicare PIN
MIE50396Medicare UPIN
MI0780209Medicare ID - Type Unspecified