Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 036139529 | IL |
Y | 207X00000X | Orthopaedic Surgeon | 75491 | WI |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 036139529 | IL |
NPI | 1124399449 |
---|---|
Provider Name | Dr. Diego Cole Villacis |
First Address | Milwaukee, WI 53215-2843 |
Second Address | Summit, WI 53066-4899 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2012 |
Last Update Date | 06/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100174818 | (05) | WI |