Provider Demographics
NPI:1447347802
Name:VILLA, EDUARDO J (MD)
Entity type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:J
Last Name:VILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EDUARDO
Other - Middle Name:DE JESUS
Other - Last Name:VILLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5140 N. CALIFORNIA AVE.
Mailing Address - Street 2:SUITE 545-GMP
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625
Mailing Address - Country:US
Mailing Address - Phone:773-907-3038
Mailing Address - Fax:773-989-3815
Practice Address - Street 1:5140 N. CALIFORNIA AVE.
Practice Address - Street 2:SUITE 545-GMP
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625
Practice Address - Country:US
Practice Address - Phone:773-907-3038
Practice Address - Fax:773-989-3815
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074074207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILNA643303Medicaid
ILE75512Medicare UPIN
ILNA643303Medicaid