Basic Information
| Provider Information | |||||||||
| NPI: | 1861483265 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VILLANUEVA | ||||||||
| FirstName: | WAYNE | ||||||||
| MiddleName: | GARCIA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 950248 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402950248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024895730 | ||||||||
| FaxNumber: | 5024895753 | ||||||||
| Practice Location | |||||||||
| Address1: | 3900 KRESGE WAY | ||||||||
| Address2: | SUITE 51 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028918981 | ||||||||
| FaxNumber: | 5028914548 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2005 | ||||||||
| LastUpdateDate: | 12/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 31793 | KY | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3697391000 | 01 | PASSPORT ADVTG - NNIKY | OTHER | 000000604904 | 01 | KY | ANTHEM - NNIKY | OTHER | 1141292 | 01 | KY | PASSPORT | OTHER | KY9351P | 01 | KY | SIHO | OTHER | 102723 | 01 | KY | SIHO - NNIKY | OTHER | 64317936 | 05 | KY | MEDICAID | 140006424 | 01 | KY | RAILROAD MCR | OTHER | 8242027 | 01 | KY | CIGNA - NNIKY | OTHER | 000000193902 | 01 | KY | ANTHEM | OTHER | 50022596 | 01 | KY | PASSPORT - NNIKY | OTHER | B06010 | 01 | KY | CUMBERLAND | OTHER | 200088270 | 05 | IN | MEDICAID | 000023035N | 01 | KY | HUMANA - NNIKY | OTHER | 00533105 | 01 | KY | MEDICARE - KY - NNIKY | OTHER | P00745281 | 01 | KY | RAILROAD MEDICARE KY - NNIKY | OTHER |