Basic Information
| Provider Information | |||||||||
| NPI: | 1538201744 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VILLAFANE | ||||||||
| FirstName: | JUAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 743 E BROADWAY # 300 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025843200 | ||||||||
| FaxNumber: | 5025843333 | ||||||||
| Practice Location | |||||||||
| Address1: | 731 E BROADWAY | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025843200 | ||||||||
| FaxNumber: | 5025843333 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 08/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0202X | 24893 | KY | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | 207RA0002X | 24893 | KY | Y |
ID Information
| ID | Type | State | Issuer | Description | 64248933 | 05 | KY | MEDICAID | 100020940 | 05 | IN | MEDICAID |