Provider Demographics
NPI:1720027675
Name:VILLACIS, CYNTHIA HUYCK (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:HUYCK
Last Name:VILLACIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3001 MAGNOLIA CT
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3306
Mailing Address - Country:US
Mailing Address - Phone:859-905-0707
Mailing Address - Fax:859-203-0853
Practice Address - Street 1:71 CAVALIER BLVD STE 316
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-5172
Practice Address - Country:US
Practice Address - Phone:859-905-0707
Practice Address - Fax:859-203-0853
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084433207Q00000X
KY35878207QA0401X, 207Q00000X
OH35.084433207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64049679Medicaid
OH2319226Medicaid
OHVI2030161Medicare PIN
H63935Medicare UPIN