MEDICARE: DR. ESTHER R SERVILLAS 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	207R00000X	Internal Medicine Physician	036143974	IL
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	036143974	IL
3	390200000X	Student in an Organized Health Care Education/Training Program
4	207R00000X	Internal Medicine Physician	4301503819	MI

General Provider Information

NPI Number	:	1922418425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ESTHER R SERVILLAS MD

Provider Business Mailing Address
First Line	:	3950 HOLLYWOOD RD STE 270
Second Line	:
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-9158
Country	:	US
Telephone Number	:	269-983-0500
Fax Number	:	269-429-2240

Provider Business Practice Location Address
First Line	:	3950 HOLLYWOOD RD STE 270
Second Line	:
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-9158
Country	:	US
Telephone Number	:	269-983-0500
Fax Number	:	269-429-2240

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

Provider Enumeration Date	:	05/06/2014
Last Update Date	:	12/13/2021

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Directions to “ DR. ESTHER R SERVILLAS MD” Practice Location

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