Individual
LYDIA SIMEONA Q VILLAFUERTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2950 S 6TH ST, SPRINGFIELD, IL 62703-5904
(217) 588-7450
(217) 588-7483
Mailing address
2950 S 6TH ST, SPRINGFIELD, IL 62703-5904
(217) 588-7450
(217) 588-7483
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036089825
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036089825
—
IL
Enumeration date
01/10/2006
Last updated
06/01/2015
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