Individual
MARIA D DE VILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1580 COMMANCHE AVE, GREEN BAY, WI 54313-5751
(920) 435-8326
(920) 430-4659
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7226
(920) 445-7229
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
24698
NE
207RX0202X
Medical Oncology Physician
Primary
65835-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100057118
—
WI
01
—
P01669360
RAILROAD MEDICARE
WI
Enumeration date
06/25/2008
Last updated
09/18/2019
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