Healthcare Provider Details

I. General information

NPI: 1619969912
Provider Name (Legal Business Name): MONTE E ROMMELMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 VILLAGE SQUARE DR
PADUCAH KY
42001-9060
US

IV. Provider business mailing address

PO BOX 7038
PADUCAH KY
42002-7038
US

V. Phone/Fax

Practice location:
  • Phone: 270-443-9352
  • Fax: 270-443-9013
Mailing address:
  • Phone: 270-443-9352
  • Fax: 270-443-9013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number28897
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: