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Individual

DR. LISA MARIE VILLANUEVA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
101 S WASHINGTON AVE, SUITE 122, PARK RIDGE, IL 60068-4200
(847) 692-6628
(847) 692-6891
Mailing address
101 S WASHINGTON AVE, SUITE 122, PARK RIDGE, IL 60068-4200
(847) 692-6628
(847) 692-6891

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036-093553
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036093553
IL
Enumeration date
08/09/2006
Last updated
12/17/2021
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