Provider Demographics
NPI:1407959414
Name:VILLAFLOR, MIRASOL D (MD)
Entity Type:Individual
Prefix:
First Name:MIRASOL
Middle Name:D
Last Name:VILLAFLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:444 N NORTHWEST HWY
Mailing Address - Street 2:SUITE #320
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3263
Mailing Address - Country:US
Mailing Address - Phone:847-696-9015
Mailing Address - Fax:847-696-9017
Practice Address - Street 1:7435 W TALCOTT AVE
Practice Address - Street 2:RMC
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3707
Practice Address - Country:US
Practice Address - Phone:773-792-5162
Practice Address - Fax:773-594-8589
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001620300OtherBLUECROSS BLUESHILD OF IL
IL036046391 2Medicaid
ILD11010Medicare UPIN
ILL50800Medicare PIN