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RAPHAEL VILLAVICENCIO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1481 W 10TH ST, MEDICINE SERVICE, 111, INDIANAPOLIS, IN 46202-2803
(317) 554-0000
Mailing address
1481 W 10TH ST, MEDICINE SERVICE, 111, INDIANAPOLIS, IN 46202-2803
(317) 554-0000

Taxonomy

Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
01051969A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000351160
ANTHEM PROVIDER NUMBER
IN
05
200300450
IN
01
9397565
PHCS PID NUMBER
IN
Enumeration date
03/20/2006
Last updated
12/03/2010
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