Provider Demographics
NPI:1538148531
Name:VILLANUEVA, LUIS NICOLAS (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:NICOLAS
Last Name:VILLANUEVA
Suffix:
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 1:930 FRANKLIN ST SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4312
Mailing Address - Country:US
Mailing Address - Phone:256-539-4080
Mailing Address - Fax:256-539-4099
Practice Address - Street 1:1121 SOMERVILLE RD SE
Practice Address - Street 2:SUITE 1
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3256
Practice Address - Country:US
Practice Address - Phone:256-340-5185
Practice Address - Fax:256-301-3870
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17898207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALF046OtherMEDICARE GROUP NPI
AL120427Medicaid
AL511-07728OtherBCBS
AL009942432Medicaid
AL51540532OtherBCBS
AL51540532OtherBCBS
ALF046OtherMEDICARE GROUP NPI