Provider Demographics
NPI:1699268268
Name:ROMANE, DOMINIC M (L/CO)
Entity type:Individual
Prefix:MR
First Name:DOMINIC
Middle Name:M
Last Name:ROMANE
Suffix:
Gender:M
Credentials:L/CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S 376 SUMMIT AVE COURT E
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181
Mailing Address - Country:US
Mailing Address - Phone:847-619-1701
Mailing Address - Fax:
Practice Address - Street 1:1701 E WOODFIELD RD STE 555
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5130
Practice Address - Country:US
Practice Address - Phone:847-619-1701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILCO005290222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist