Healthcare Provider Details

I. General information

NPI: 1003062019
Provider Name (Legal Business Name): LEE HOWARD ROME M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2008
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6860 WELLINGTON DR
DEXTER MI
48130-2513
US

IV. Provider business mailing address

13308 SE 306TH ST
AUBURN WA
98092-3279
US

V. Phone/Fax

Practice location:
  • Phone: 734-424-0194
  • Fax:
Mailing address:
  • Phone: 734-476-9993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301038144
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: