Healthcare Provider Details

I. General information

NPI: 1548962772
Provider Name (Legal Business Name): JUSTIN ROBERT VILASECA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

974 HIGHWAY 321 N
LENOIR CITY TN
37771-2175
US

IV. Provider business mailing address

2086 CASABLANCA WAY
KNOXVILLE TN
37932-3390
US

V. Phone/Fax

Practice location:
  • Phone: 865-986-2700
  • Fax: 865-986-8096
Mailing address:
  • Phone: 786-208-8615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number993
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: