MEDICARE: LUBOV ROMANTSEVA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0600X	Clinical Neurophysiology Physician	036-117088	IL
2	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	036117088	IL

General Provider Information

NPI Number	:	1851558001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUBOV ROMANTSEVA MD

Provider Business Mailing Address
First Line	:	1725 W HARRISON ST STE 718
Second Line	:	DEPARTMENT OF PEDIATRICS, SECTION OF CHILD NEUROLOGY
City	:	CHICAGO
State	:	IL
Zip	:	60612-3863
Country	:	US
Telephone Number	:	312-942-3034
Fax Number	:	312-942-4168

Provider Business Practice Location Address
First Line	:	1725 W HARRISON ST STE 718
Second Line	:	DEPARTMENT OF PEDIATRICS, SECTION OF CHILD NEUROLOGY
City	:	CHICAGO
State	:	IL
Zip	:	60612-3863
Country	:	US
Telephone Number	:	312-942-3034
Fax Number	:	312-942-4168

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	04/29/2021

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