MEDICARE: DR. ROMEO B BIBOSO 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	208D00000X	General Practice Physician	17363020	WI
2	208VP0014X	Interventional Pain Medicine Physician	17363020	WI

General Provider Information

NPI Number	:	1821104795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROMEO B BIBOSO MD

Provider Business Mailing Address
First Line	:	5401 DOUGLAS AVE
Second Line	:	STE A
City	:	RACINE
State	:	WI
Zip	:	53402
Country	:	US
Telephone Number	:	262-681-8829
Fax Number	:	262-681-8830

Provider Business Practice Location Address
First Line	:	5401 DOUGLAS AVE
Second Line	:	STE A
City	:	RACINE
State	:	WI
Zip	:	53402
Country	:	US
Telephone Number	:	262-681-8829
Fax Number	:	262-681-8830

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	03/08/2026

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