Individual
AMY V VILLAVICENCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
550 S HOKE AVE, FRANKFORT, IN 46041-2664
(765) 448-8000
(765) 659-2577
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01060760A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000490525
ANTHEM PROVIDER NUMBER
IN
01
—
11492358
CAQH NUMBER
IN
05
—
200538780
—
IN
01
—
9397563
PHCS PID NUMBER
IN
Enumeration date
03/22/2006
Last updated
03/01/2021
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