MEDICARE: POOLE AND VILLANI, M.D.,'S, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053473132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POOLE AND VILLANI, M.D.,'S, P.A.

Provider Business Mailing Address
First Line	:	1111 KANE CONCOURSE STE 607
Second Line	:
City	:	BAY HARBOR ISLANDS
State	:	FL
Zip	:	33154-2044
Country	:	US
Telephone Number	:	305-674-2047
Fax Number	:	305-674-2939

Provider Business Practice Location Address
First Line	:	1111 KANE CONCOURSE STE 607
Second Line	:
City	:	BAY HARBOR ISLANDS
State	:	FL
Zip	:	33154-2044
Country	:	US
Telephone Number	:	305-674-2047
Fax Number	:	305-674-2939

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LUIS DIEGO VILLANI
Credential	:	MD
Telephone Number	:	305-674-2047

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	11/16/2020

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