Provider Demographics
NPI:1457415176
Name:VILLEGAS, STEVEN DONACIANO (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DONACIANO
Last Name:VILLEGAS
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 1:3005 DIXIE HWY STE 20
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2380
Mailing Address - Country:US
Mailing Address - Phone:859-426-1000
Mailing Address - Fax:859-426-7107
Practice Address - Street 1:3005 DIXIE HWY STE 20
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-2380
Practice Address - Country:US
Practice Address - Phone:859-426-1000
Practice Address - Fax:859-426-7107
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35720207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI 0895602Medicare ID - Type Unspecified
E67756Medicare UPIN