Active NPI
Douglas Lewis Villa, MD
- Family Medicine Physician
- Iron Mountain, MI
National Provider Identifier
1508969155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 4301044982
- Practice address
- 212 E B St
Iron Mountain, MI 49801-3411 - Phone
- (906) 774-2990
- Fax
- (906) 774-5950
- NPI assigned
- Sep 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4301044982 | MI | Primary |
Addresses
Primary practice location
212 E B St
Iron Mountain, MI 49801-3411
Mailing address
212 East B St
Iron Mountain, MI 49801
Phone (906) 774-2990
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30637100 | Medicaid | WI | |
| 080007579 | Other | RAILROAD MEDICARE | |
| 1631523 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301044982 | MI | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315440000000",
"number": "1508969155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "212 EAST B ST",
"city": "IRON MOUNTAIN",
"state": "MI",
"postal_code": "49801",
"telephone_number": "906-774-2990",
"fax_number": "906-774-5950"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "212 E B ST",
"city": "IRON MOUNTAIN",
"state": "MI",
"postal_code": "498013411",
"telephone_number": "906-774-2990",
"fax_number": "906-774-5950"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VILLA",
"first_name": "DOUGLAS",
"middle_name": "LEWIS",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-07",
"last_updated": "2011-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "4301044982",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30637100",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "080007579",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1631523",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Iron Mountain, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.