Provider Demographics
NPI:1053473132
Name:POOLE AND VILLANI, M.D.,'S, P.A.
Entity Type:Organization
Organization Name:POOLE AND VILLANI, M.D.,'S, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:DIEGO
Authorized Official - Last Name:VILLANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-674-2047
Mailing Address - Street 1:1111 KANE CONCOURSE STE 607
Mailing Address - Street 2:
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2044
Mailing Address - Country:US
Mailing Address - Phone:305-674-2047
Mailing Address - Fax:305-674-2939
Practice Address - Street 1:1111 KANE CONCOURSE STE 607
Practice Address - Street 2:
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2044
Practice Address - Country:US
Practice Address - Phone:305-674-2047
Practice Address - Fax:305-674-2939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00610119 00Medicaid
FL99122Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER