MEDICARE: ROMA LUBOW ILKIW 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	2080P0202X	Pediatric Cardiology Physician	H8692	TX

General Provider Information

NPI Number	:	1740794130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROMA LUBOW ILKIW MD

Provider Business Mailing Address
First Line	:	6624 FANNIN ST STE 1450
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2385
Country	:	US
Telephone Number	:	713-799-9916
Fax Number	:	713-799-9917

Provider Business Practice Location Address
First Line	:	6624 FANNIN ST STE 1450
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2385
Country	:	US
Telephone Number	:	713-799-9916
Fax Number	:	713-799-9917

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

Provider Enumeration Date	:	11/22/2017
Last Update Date	:	06/16/2018

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