MEDICARE: ROMEO LAGROSA MD

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	207Q00000X	Family Medicine Physician		IL

General Provider Information

NPI Number	:	1316079593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROMEO LAGROSA MD

Provider Business Mailing Address
First Line	:	1 TIFFANY PT
Second Line	:	SUITE G-18
City	:	BLOOMINGDALE
State	:	IL
Zip	:	60108-2936
Country	:	US
Telephone Number	:	630-980-8410
Fax Number	:	630-980-8418

Provider Business Practice Location Address
First Line	:	8965 W GOLF RD
Second Line	:
City	:	NILES
State	:	IL
Zip	:	60714-5812
Country	:	US
Telephone Number	:	847-795-8600
Fax Number	:	847-795-8602

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	02/01/2008

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