MEDICARE: MR. MICHAEL DENNIS ROMANOW CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	4704116239	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CG1308	OTHER	MI	MEDICARE RAILROAD
3	0M58250	OTHER	MI	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	430B810310	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1033102462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL DENNIS ROMANOW CRNA

Provider Business Mailing Address
First Line	:	1447 N HARRISON ST
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48602-4727
Country	:	US
Telephone Number	:	989-583-2794
Fax Number	:

Provider Business Practice Location Address
First Line	:	1447 N HARRISON ST
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48602-4727
Country	:	US
Telephone Number	:	989-583-2794
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	06/13/2014

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