Provider Demographics
NPI:1861483265
Name:VILLANUEVA, WAYNE GARCIA (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:GARCIA
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:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-489-5730
Mailing Address - Fax:502-489-5753
Practice Address - Street 1:3900 KRESGE WAY
Practice Address - Street 2:SUITE 51
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4660
Practice Address - Country:US
Practice Address - Phone:502-891-8981
Practice Address - Fax:502-891-4548
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31793207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
3697391000OtherPASSPORT ADVTG - NNIKY
KY000000604904OtherANTHEM - NNIKY
KY1141292OtherPASSPORT
KYKY9351POtherSIHO
KY102723OtherSIHO - NNIKY
KY64317936Medicaid
KY140006424OtherRAILROAD MCR
KY8242027OtherCIGNA - NNIKY
KY000000193902OtherANTHEM
KY50022596OtherPASSPORT - NNIKY
KYB06010OtherCUMBERLAND
IN200088270Medicaid
KY000023035NOtherHUMANA - NNIKY
KY00533105OtherMEDICARE - KY - NNIKY
KYP00745281OtherRAILROAD MEDICARE KY - NNIKY
KY8242027OtherCIGNA - NNIKY
KY000000604904OtherANTHEM - NNIKY
IN200088270Medicaid