Healthcare Provider Details

I. General information

NPI: 1851558001
Provider Name (Legal Business Name): LUBOV ROMANTSEVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST STE 718 DEPARTMENT OF PEDIATRICS, SECTION OF CHILD NEUROLOGY
CHICAGO IL
60612-3863
US

IV. Provider business mailing address

1725 W HARRISON ST STE 718 DEPARTMENT OF PEDIATRICS, SECTION OF CHILD NEUROLOGY
CHICAGO IL
60612-3863
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-3034
  • Fax: 312-942-4168
Mailing address:
  • Phone: 312-942-3034
  • Fax: 312-942-4168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number036-117088
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number036117088
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: