Provider Demographics
NPI:1316913775
Name:AGUILAR, VIRGILIO M JR (MD)
Entity type:Individual
Prefix:
First Name:VIRGILIO
Middle Name:M
Last Name:AGUILAR
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9223 CORNELL BAY
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-9329
Mailing Address - Country:US
Mailing Address - Phone:651-357-0752
Mailing Address - Fax:
Practice Address - Street 1:1925 WOODWINDS DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2270
Practice Address - Country:US
Practice Address - Phone:651-426-1980
Practice Address - Fax:651-232-0100
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42383207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN158497900Medicaid
MN110006916Medicare ID - Type Unspecified
MN158497900Medicaid