Provider Demographics
NPI:1457325334
Name:VILLARROEL FERNANDEZ, OMAR MIJAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:MIJAEL
Last Name:VILLARROEL FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:OMAR
Other - Middle Name:MIJAEL
Other - Last Name:VILLARROEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3870
Mailing Address - Country:US
Mailing Address - Phone:800-893-9698
Mailing Address - Fax:
Practice Address - Street 1:1401 E STATE ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-2315
Practice Address - Country:US
Practice Address - Phone:912-658-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058592208M00000X, 208000000X
IL036117065208M00000X, 208000000X
IDM-16558208M00000X
MO2018018492208000000X, 208M00000X
NC2008-01887208000000X
NMMD2005-0619208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist