Healthcare Provider Details

I. General information

NPI: 1518186824
Provider Name (Legal Business Name): MARIA JUSTINA VILLANO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 W RAND RD STE 210
ARLINGTON HEIGHTS IL
60004-2315
US

IV. Provider business mailing address

1051 W RAND RD STE 210
ARLINGTON HEIGHTS IL
60004-2315
US

V. Phone/Fax

Practice location:
  • Phone: 847-725-8453
  • Fax: 847-454-2236
Mailing address:
  • Phone: 847-725-8401
  • Fax: 847-454-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number57006090
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number036-125299
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: