MEDICARE: ROMEO S. AMBROSIO M.D.

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	207V00000X	Obstetrics & Gynecology Physician	41426	KY
2	207Q00000X	Family Medicine Physician	41426	KY
3	207V00000X	Obstetrics & Gynecology Physician	01064174A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
11	196290YYY	OTHER	IN	MEDICARE - CMA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	089399	OTHER		SIHO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0101238280	OTHER	VA	LICENSE
5	3873422	OTHER	KY	CIGNA
6	50015846	OTHER	KY	PASSPORT (OB/GYN)
7	2858785000	OTHER	LA	PASSPORT ADVNTG
8	50016558	OTHER	KY	PASSPORT - PCP
9	530495	OTHER	KY	ANTHEM
10	000023028Q	OTHER		HUMANA

General Provider Information

NPI Number	:	1194847871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROMEO S. AMBROSIO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 776351
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6351
Country	:	US
Telephone Number	:	502-588-9490
Fax Number	:	502-272-5116

Provider Business Practice Location Address
First Line	:	601 S FLOYD ST STE 500
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-1837
Country	:	US
Telephone Number	:	502-629-1515
Fax Number	:	502-629-1545

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	03/02/2026

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