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General NPI Number Information
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NPI Number | 1124058029
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Entity Type | Organization
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Legal Business Name | VILLA MEDICAL ARTS
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 33 S. VILLA AVE. SUITE 2
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City | VILLA PARK
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State | IL
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Zip | 60181
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Country | US
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Telephone | 630-832-9000
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Fax | 630-832-7907
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Provider Business Mailing Address
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Address Line | 33 S. VILLA AVE. SUITE 2
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City | VILLA PARK
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State | IL
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Zip | 60181
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Country | US
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Telephone | 630-832-9000
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Fax | 630-832-7907
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | DEEPA FULTON
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Credential |
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Telephone | 630-832-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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