Provider Demographics
NPI:1164667424
Name:VILLEGAS-GARCIA, JUAN-FERNANDO (MD)
Entity Type:Individual
Prefix:
First Name:JUAN-FERNANDO
Middle Name:
Last Name:VILLEGAS-GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 N PEORIA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-6739
Mailing Address - Country:US
Mailing Address - Phone:248-506-5169
Mailing Address - Fax:
Practice Address - Street 1:CALIFORNIA AVE AT 15TH STREET
Practice Address - Street 2:ROOM C 1400
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608
Practice Address - Country:US
Practice Address - Phone:773-257-5097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301092105207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine