Organization
ROMEO S. MICLAT, M.D., INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROMEO S MICLAT M.D. (PHYSICIAN)
(440) 365-9371
Entity
Organization
Contact information
Practice address
1060 N ABBE ROAD, ELYRIA, OH 44035
(440) 365-9371
(440) 366-6033
Mailing address
1060 N ABBE ROAD, ELYRIA, OH 44035
(440) 365-9371
(440) 366-6033
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
35-038552
OH
207R00000X
Internal Medicine Physician
35-038553
OH
207RN0300X
Nephrology Physician
Primary
35-038553
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000498009
ANTHEM NEPH
OH
01
—
000000498011
ANTHEM IM
OH
05
—
2079656
—
OH
01
—
35-038553
LICENSE NUMBER
OH
01
—
CG6814
RAILROAD MEDICARE
OH
Enumeration date
12/29/2006
Last updated
04/29/2024
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