Provider Demographics
NPI:1508864794
Name:VILLANI, PATRICK A (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:A
Last Name:VILLANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:19701 VERNIER RD
Mailing Address - Street 2:SUITE #170
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-1491
Mailing Address - Country:US
Mailing Address - Phone:313-885-3800
Mailing Address - Fax:313-885-1121
Practice Address - Street 1:19701 VERNIER RD
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1467
Practice Address - Country:US
Practice Address - Phone:313-885-3800
Practice Address - Fax:313-885-1121
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIPV025256207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1044369Medicaid
MI0829206Medicare PIN
MI0P58340Medicare PIN