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NPI Code Detail

MEDICARE: WILMER FERNANDO DAVILA M.D.

MEDICARE: WILMER FERNANDO DAVILA M.D.
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
1207L00000XAnesthesiology Physician0136156121IL

General Provider Information

NPI Number : 1063945939
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILMER FERNANDO DAVILA M.D.
Provider Business Mailing Address
First Line : 2650 RIDGE AVE STE 1223
Second Line :
City : EVANSTON
State : IL
Zip : 60201-1700
Country : US
Telephone Number : 847-570-2040
Fax Number :
Provider Business Practice Location Address
First Line : 5145 N CALIFORNIA AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60625-3661
Country : US
Telephone Number : 773-293-5486
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2017
Last Update Date : 04/16/2026

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