Healthcare Provider Details

I. General information

NPI: 1780388868
Provider Name (Legal Business Name): ALYSSA MICHELLE VILLACRES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 S YEARLING RD
WHITEHALL OH
43213-2894
US

IV. Provider business mailing address

5000 RADSTOCK CT
HILLIARD OH
43026-9533
US

V. Phone/Fax

Practice location:
  • Phone: 614-235-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.156938
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: