Provider Demographics
NPI:1366232605
Name:VILLA, ALEXIS SR
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:VILLA
Suffix:SR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2941 W 101ST PL
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-3542
Mailing Address - Country:US
Mailing Address - Phone:971-517-5726
Mailing Address - Fax:312-668-9365
Practice Address - Street 1:8450 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-3341
Practice Address - Country:US
Practice Address - Phone:312-668-9719
Practice Address - Fax:312-668-9365
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)