MEDICARE: DR. EDWARD EUSEBIO VILLANUEVA DPM

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	213E00000X	Podiatrist	SC003875L	PA
2	213ES0131X	Foot Surgery Podiatrist	SC003875L	PA

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

General Provider Information

NPI Number	:	1346233053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD EUSEBIO VILLANUEVA DPM

Provider Business Mailing Address
First Line	:	2501 GARRETT RD
Second Line	:
City	:	DREXEL HILL
State	:	PA
Zip	:	19026-1010
Country	:	US
Telephone Number	:	610-623-3540
Fax Number	:	610-623-2327

Provider Business Practice Location Address
First Line	:	2501 GARRETT RD
Second Line	:
City	:	DREXEL HILL
State	:	PA
Zip	:	19026-1010
Country	:	US
Telephone Number	:	610-623-3540
Fax Number	:	610-623-2327

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

Provider Enumeration Date	:	08/27/2005
Last Update Date	:	01/07/2011

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