Provider Demographics
NPI:1255334058
Name:VILLARREAL, KATHLEEN M (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:272 HOSPITAL RD STE 6
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-9031
Mailing Address - Country:US
Mailing Address - Phone:740-779-4222
Mailing Address - Fax:740-779-4257
Practice Address - Street 1:626 CENTRAL CTR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2248
Practice Address - Country:US
Practice Address - Phone:740-779-4060
Practice Address - Fax:740-779-4069
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.0772266207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2024704Medicaid
OH0833672OtherRAILROAD MEDICARE
OH2024704Medicaid
OH0403614OtherUNITED HEALTHCARE
OH000000121570OtherANTHEM
OHG58826Medicare UPIN