Provider Demographics
NPI:1316079593
Name:LAGROSA, ROMEO (MD)
Entity type:Individual
Prefix:
First Name:ROMEO
Middle Name:
Last Name:LAGROSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 TIFFANY PT
Mailing Address - Street 2:SUITE G-18
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2936
Mailing Address - Country:US
Mailing Address - Phone:630-980-8410
Mailing Address - Fax:630-980-8418
Practice Address - Street 1:8965 W GOLF RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-5812
Practice Address - Country:US
Practice Address - Phone:847-795-8600
Practice Address - Fax:847-795-8602
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK46188Medicare PIN