Healthcare Provider Details

I. General information

NPI: 1861788192
Provider Name (Legal Business Name): GENARO FRANCISCO VALLADOLID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GENARO FRANCISCO VALLADOLID MUNGUIA M.D.

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 BARNHILL DR EMERSON HALL, STE 232
INDIANAPOLIS IN
46202-5112
US

IV. Provider business mailing address

545 BARNHILL DR EMERSON HALL, STE 232
INDIANAPOLIS IN
46202-5112
US

V. Phone/Fax

Practice location:
  • Phone: 317-278-0394
  • Fax:
Mailing address:
  • Phone: 317-278-0394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number58065
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number125.059987
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number01076801A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: