Healthcare Provider Details

I. General information

NPI: 1932450996
Provider Name (Legal Business Name): MATTHEW FRANK VILLANI D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2012
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 WATERMAN WAY
TAVARES FL
32778-5252
US

IV. Provider business mailing address

PO BOX 935921
ATLANTA GA
31193-5921
US

V. Phone/Fax

Practice location:
  • Phone: 352-253-3251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3698
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: