Healthcare Provider Details

I. General information

NPI: 1003506353
Provider Name (Legal Business Name): MARK ROMANO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W FAIR AVE STE 36
MARQUETTE MI
49855-2675
US

IV. Provider business mailing address

1414 W FAIR AVE STE 36
MARQUETTE MI
49855-2675
US

V. Phone/Fax

Practice location:
  • Phone: 906-449-1010
  • Fax:
Mailing address:
  • Phone: 906-449-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101028858
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: