Healthcare Provider Details

I. General information

NPI: 1689179301
Provider Name (Legal Business Name): JORGE ISMAEL ROMO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9410 CALUMET AVE
MUNSTER IN
46321-2921
US

IV. Provider business mailing address

29943 NETWORK PL
CHICAGO IL
60673-1299
US

V. Phone/Fax

Practice location:
  • Phone: 317-706-7246
  • Fax:
Mailing address:
  • Phone: 317-706-3415
  • Fax: 317-706-3417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036153646
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number01099365A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number01099365A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: