Healthcare Provider Details

I. General information

NPI: 1144516642
Provider Name (Legal Business Name): PAULA YANINA VILLAREJO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 CENTRAL AVE
COLUMBUS IN
47203-1851
US

IV. Provider business mailing address

PO BOX 775383
CHICAGO IL
60677-5383
US

V. Phone/Fax

Practice location:
  • Phone: 812-376-9427
  • Fax: 812-378-6174
Mailing address:
  • Phone: 812-375-3000
  • Fax: 812-375-3477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number07073927A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125060367
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: