Healthcare Provider Details

I. General information

NPI: 1447347802
Provider Name (Legal Business Name): EDUARDO J. VILLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: EDUARDO DE JESUS VILLA MD

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 N. CALIFORNIA AVE. SUITE 545-GMP
CHICAGO IL
60625
US

IV. Provider business mailing address

5140 N. CALIFORNIA AVE. SUITE 545-GMP
CHICAGO IL
60625
US

V. Phone/Fax

Practice location:
  • Phone: 773-907-3038
  • Fax: 773-989-3815
Mailing address:
  • Phone: 773-907-3038
  • Fax: 773-989-3815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036074074
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: