Provider Demographics
NPI:1871634774
Name:VILLEGAS, ERNESTO J (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:J
Last Name:VILLEGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:311 N ABERDEEN ST
Mailing Address - Street 2:STE 100B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1249
Mailing Address - Country:US
Mailing Address - Phone:312-733-0909
Mailing Address - Fax:312-733-0908
Practice Address - Street 1:311 N ABERDEEN ST
Practice Address - Street 2:STE 100B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1249
Practice Address - Country:US
Practice Address - Phone:312-733-0909
Practice Address - Fax:312-733-0908
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636562OtherBLUE CROSS BLUE SHIELD
ILE23671Medicare UPIN