Healthcare Provider Details

I. General information

NPI: 1932207610
Provider Name (Legal Business Name): SYLVIA M VILLARES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S WOOD ST MC856
CHICAGO IL
60612-4325
US

IV. Provider business mailing address

840 S WOOD ST MC856
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-7416
  • Fax: 312-413-0243
Mailing address:
  • Phone: 312-996-7416
  • Fax: 312-413-0243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036116780
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: