Individual
IAN A VILLANUEVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
208 ASHVILLE AVE, SUITE 14, CARY, NC 27518-6678
(919) 350-9625
(919) 851-6757
Mailing address
2920 HIGHWOODS BLVD, RALEIGH, NC 27604-0010
(877) 498-4490
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
04-33427
KS
208600000X
Surgery Physician
Primary
2007-00579
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107539
BLUE CROSS OF KANSAS
KS
05
—
1225256076
—
NC
01
—
145WE
NCBCBS
NC
05
—
200585090A
—
KS
05
—
5907030
—
NC
01
—
N0057H
MEDICAID
SC
05
—
N0057H
—
SC
Enumeration date
04/24/2007
Last updated
04/14/2021
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