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General NPI Number Information
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NPI Number | 1639435209
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Entity Type | Individual
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Provider Name | EDWARD CHARLES VILLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/07/2012
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Last Update Date | 06/27/2019
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Provider Practice Location Address
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Address Line | 840 S WOOD ST SUITE 718E CSB, MC 716
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City | CHICAGO
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State | IL
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Zip | 60612
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Country | US
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Telephone | 312-996-6652
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Fax |
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Provider Business Mailing Address
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Address Line | 235 W VAN BUREN ST UNIT 2108
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City | CHICAGO
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State | IL
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Zip | 60607-3918
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Country | US
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Telephone | 847-668-3875
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036.137394
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 036.137394
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License Number State | IL
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