Provider Demographics
NPI:1982643102
Name:ROM, MICHAEL ELIYAHU (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ELIYAHU
Last Name:ROM
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:9485 MENTOR AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-8723
Mailing Address - Country:US
Mailing Address - Phone:440-286-1188
Mailing Address - Fax:440-286-1221
Practice Address - Street 1:9485 MENTOR AVE STE 200
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8723
Practice Address - Country:US
Practice Address - Phone:440-286-1188
Practice Address - Fax:440-286-1221
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061162207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0827761Medicare ID - Type Unspecified
D93603Medicare UPIN
RO0697973Medicare ID - Type Unspecified