Provider Demographics
NPI:1922418425
Name:SERVILLAS, ESTHER R (MD)
Entity Type:Individual
Prefix:DR
First Name:ESTHER
Middle Name:R
Last Name:SERVILLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ESTHER
Other - Middle Name:
Other - Last Name:RAMOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3950 HOLLYWOOD RD STE 270
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9158
Mailing Address - Country:US
Mailing Address - Phone:269-983-0500
Mailing Address - Fax:269-429-2240
Practice Address - Street 1:3950 HOLLYWOOD RD STE 270
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9158
Practice Address - Country:US
Practice Address - Phone:269-983-0500
Practice Address - Fax:269-429-2240
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036143974207R00000X, 207RG0300X
390200000X
MI4301503819207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program