MEDICARE: JUAN MARIO VILLAFANI MD FACS

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	208600000X	Surgery Physician	J9930	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0019BY	OTHER	TX	GROUP MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	111815002	OTHER	TX	GROUP TPI- MILLENNIUM PHYSICIANS ASSOCIATION, PLLC
4	1255397733	OTHER	TX	GROUP NPI

General Provider Information

NPI Number	:	1104882992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN MARIO VILLAFANI MD FACS

Provider Business Mailing Address
First Line	:	22710 PROFESSIONAL DR
Second Line	:	STE 102
City	:	KINGWOOD
State	:	TX
Zip	:	77339-6008
Country	:	US
Telephone Number	:	281-548-3555
Fax Number	:	281-548-3552

Provider Business Practice Location Address
First Line	:	19701 KINGWOOD DR
Second Line	:	BLDG 9
City	:	KINGWOOD
State	:	TX
Zip	:	77339-3773
Country	:	US
Telephone Number	:	281-548-3555
Fax Number	:	281-548-3552

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	04/26/2017

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