Provider Demographics
NPI:1518063205
Name:VILLEGAS, JOEL P (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:P
Last Name:VILLEGAS
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 1:370 LARRY POWER RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-5195
Mailing Address - Country:US
Mailing Address - Phone:815-523-7020
Mailing Address - Fax:815-523-7022
Practice Address - Street 1:370 LARRY POWER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-5195
Practice Address - Country:US
Practice Address - Phone:815-523-7020
Practice Address - Fax:815-523-7022
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090542207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4632039OtherBC GROUP NUMBER
IL36090542Medicaid
IL36090542Medicaid
IL4632039OtherBC GROUP NUMBER
IL36-3167726Medicare ID - Type UnspecifiedMEDICARE TAX ID#
IL356253Medicare ID - Type UnspecifiedMEDICARE GROUP #