Individual
DR. GENEROSE VILLANUEVA TEJADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4199 GATEWAY BLVD, NEWBURGH, IN 47630-8940
(812) 842-4200
(812) 602-3174
Mailing address
2304 KOSSUTH ST, LAFAYETTE, IN 47904-3240
(765) 446-9600
(765) 446-1100
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
01067759A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201007190
—
IN
Enumeration date
11/03/2006
Last updated
11/21/2019
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