MEDICARE: DR. MARIA S VILLEGAS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	036104837	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4632039	OTHER	IL	BC GROUP #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033217104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA S VILLEGAS MD

Provider Business Mailing Address
First Line	:	PO BOX 781
Second Line	:
City	:	KANKAKEE
State	:	IL
Zip	:	60901-0781
Country	:	US
Telephone Number	:	815-935-7256
Fax Number	:	815-935-7340

Provider Business Practice Location Address
First Line	:	400 N WALL ST
Second Line	:	SUITE 405
City	:	KANKAKEE
State	:	IL
Zip	:	60901-2940
Country	:	US
Telephone Number	:	815-932-6632
Fax Number	:	815-932-5760

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	03/29/2021

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