Provider Demographics
NPI:1538276894
Name:ROMAN, EKATERINA (MD)
Entity type:Individual
Prefix:DR
First Name:EKATERINA
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EKATERINA
Other - Middle Name:
Other - Last Name:KRASIKOVA
Other - Suffix:
Other - Last Name Type:Doing Business As
Other - Credentials:
Mailing Address - Street 1:1205 COPPER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:IA
Mailing Address - Zip Code:50327-7002
Mailing Address - Country:US
Mailing Address - Phone:515-266-1199
Mailing Address - Fax:515-266-0615
Practice Address - Street 1:1205 COPPER CREEK DR
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:IA
Practice Address - Zip Code:50327-7002
Practice Address - Country:US
Practice Address - Phone:515-266-1199
Practice Address - Fax:515-266-0615
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45252207Q00000X
IAMD-42730207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine