Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 036-145846 | IL |
N | 208600000X | Surgeon | 036-145846 | IL |
Y | 2086S0120X | Pediatric Surgery | 036145846 | IL |
NPI | 1336382670 |
---|---|
Provider Name | Ms. Carmelle Valerie Romain |
First Address | Burr Ridge, IL 60527-5965 |
Second Address | Chicago, IL 60637-1443 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2009 |
Last Update Date | 05/09/2018 |