Provider Demographics
NPI:1902371404
Name:VILLACORTA CARI, EVELYN BERTHA (MD)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:BERTHA
Last Name:VILLACORTA CARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 S LIMESTONE FIFTH FLOOR - WING D ROOM L504
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:859-257-9813
Practice Address - Street 1:3101 BEAUMONT CENTRE CIR STE 100
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1959
Practice Address - Country:US
Practice Address - Phone:859-323-5544
Practice Address - Fax:859-257-9288
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYFT592207RI0200X
KY54785207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease