Healthcare Provider Details

I. General information

NPI: 1003999293
Provider Name (Legal Business Name): MICHAEL D VILLWOCK APRN, CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15300 WEST AVE STE 20
ORLAND PARK IL
60462-4504
US

IV. Provider business mailing address

15300 WEST AVE STE 20
ORLAND PARK IL
60462-4504
US

V. Phone/Fax

Practice location:
  • Phone: 708-460-5550
  • Fax: 708-226-2595
Mailing address:
  • Phone: 708-460-5550
  • Fax: 708-226-2595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209001480
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209001480
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number209000502
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number041-224149
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: