Healthcare Provider Details

I. General information

NPI: 1023069481
Provider Name (Legal Business Name): MICHAEL E VILLANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 NE REVERE AVE SUITE B
BEND OR
97701-6752
US

IV. Provider business mailing address

431 NE REVERE AVE
BEND OR
97701-4189
US

V. Phone/Fax

Practice location:
  • Phone: 541-312-1145
  • Fax:
Mailing address:
  • Phone: 541-312-1145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD22932
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: