Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | IL |
NPI | 1003999293 |
---|---|
Provider Name | Michael D Villwock |
First Address | Chicago, IL 60612-4305 |
Second Address | Chicago, IL 60612-7232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 08/07/2007 |