Provider Demographics
NPI:1033217104
Name:VILLEGAS, MARIA S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:S
Last Name:VILLEGAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 781
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-0781
Mailing Address - Country:US
Mailing Address - Phone:815-935-7256
Mailing Address - Fax:815-935-7340
Practice Address - Street 1:400 N WALL ST
Practice Address - Street 2:SUITE 405
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2940
Practice Address - Country:US
Practice Address - Phone:815-932-6632
Practice Address - Fax:815-932-5760
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104837208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4632039OtherBC GROUP #
IL36104837Medicaid
ILK25727Medicare PIN
IL36104837Medicaid
IL36-3167726Medicare ID - Type UnspecifiedMEDICARE TAX ID#
ILH54217Medicare UPIN