Provider Demographics
NPI:1962498782
Name:VILLANI, LUIS DIEGO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:DIEGO
Last Name:VILLANI
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 1:1111 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
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL75837207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254415600Medicaid
FLE1393ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER #
FL254415600Medicaid