Healthcare Provider Details

I. General information

NPI: 1508992561
Provider Name (Legal Business Name): JEFFREY ROMIG P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W WINDSOR RD
CHAMPAIGN IL
61822-6217
US

IV. Provider business mailing address

101 W UNIVERSITY AVE
CHAMPAIGN IL
61820-3981
US

V. Phone/Fax

Practice location:
  • Phone: 217-366-8130
  • Fax: 217-366-7488
Mailing address:
  • Phone: 217-366-8130
  • Fax: 217-366-7488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085001235
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: