Provider Demographics
NPI:1528086683
Name:ROMERO, MARTIN R (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:R
Last Name:ROMERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3096 BURKLEY RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48895
Mailing Address - Country:US
Mailing Address - Phone:517-303-9564
Mailing Address - Fax:517-336-9122
Practice Address - Street 1:3096 BURKLEY RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:MI
Practice Address - Zip Code:48895-9065
Practice Address - Country:US
Practice Address - Phone:517-303-9564
Practice Address - Fax:517-336-9122
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI081986207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00380133OtherRAILROAD MEDICARE
MI200000002727OtherPHP & PHPFC
MI4890832Medicaid
MI0103313092OtherBLUE CROSS BLUE SHIELD
MIP00380133OtherRAILROAD MEDICARE