Individual
MIRKO VILLANUEVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 EAST MEDICAL CENTER DR, 7TH FLOOR MED INN, ANN ARBOR, MI 48109-5845
(734) 936-9068
Mailing address
3621 S STATE ST, 700 KMS PLACE, ANN ARBOR, MI 48108
(734) 936-2047
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
17917
MS
207R00000X
Internal Medicine Physician
Primary
4301073838
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03189816
—
MS
Enumeration date
04/25/2006
Last updated
12/11/2013
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