Basic Information
| Provider Information | |||||||||
| NPI: | 1780716027 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOUISVILLE NEUROSCIENCE INSTITUTE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3900 KRESGE WAY | ||||||||
| Address2: | SUITE 51 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028918981 | ||||||||
| FaxNumber: | 5028914548 | ||||||||
| Practice Location | |||||||||
| Address1: | 3900 KRESGE WAY | ||||||||
| Address2: | SUITE 51 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028918981 | ||||||||
| FaxNumber: | 5028914548 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2007 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | VILLANUEVA | ||||||||
| AuthorizedOfficialFirstName: | WAYNE | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 5028918981 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.