Provider Demographics
NPI:1831331289
Name:CHAVES VILLAMIL, LUIS GUILLERMO (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:GUILLERMO
Last Name:CHAVES VILLAMIL
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 1:540 BRICKELL KEY DR
Mailing Address - Street 2:#1226
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2697
Mailing Address - Country:US
Mailing Address - Phone:786-879-2816
Mailing Address - Fax:
Practice Address - Street 1:1400 E OAKLAND PARK BLVD
Practice Address - Street 2:STE 210
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-4400
Practice Address - Country:US
Practice Address - Phone:954-561-6222
Practice Address - Fax:954-990-7650
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2014-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1157442084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013193800Medicaid
FLHX727ZOtherMEDICARE PTAN
FLHX727ZOtherMEDICARE PTAN