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1457325334

NPI Code Detail

MEDICARE: DR. OMAR MIJAEL VILLARROEL FERNANDEZ MD

MEDICARE: DR. OMAR MIJAEL VILLARROEL FERNANDEZ 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	208M00000X	Hospitalist Physician	058592	GA
2	208M00000X	Hospitalist Physician	036117065	IL
3	208M00000X	Hospitalist Physician	M-16558	ID
4	208000000X	Pediatrics Physician	2018018492	MO
5	208000000X	Pediatrics Physician	2008-01887	NC
6	208000000X	Pediatrics Physician	MD2005-0619	NM
7	208000000X	Pediatrics Physician	058592	GA
8	208000000X	Pediatrics Physician	036117065	IL
9	208M00000X	Hospitalist Physician	2018018492	MO

General Provider Information

NPI Number	:	1457325334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OMAR MIJAEL VILLARROEL FERNANDEZ MD

Provider Business Mailing Address
First Line	:	200 CORPORATE BLVD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-3870
Country	:	US
Telephone Number	:	800-893-9698
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 E STATE ST
Second Line	:	3RD FLOOR
City	:	ROCKFORD
State	:	IL
Zip	:	61104-2315
Country	:	US
Telephone Number	:	912-658-1155
Fax Number	:

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	08/11/2022

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Directions to “ DR. OMAR MIJAEL VILLARROEL FERNANDEZ MD” Practice Location

Language	Start Address	Practice Location

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