Provider Demographics
NPI:1689755886
Name:BILLENA, RAYMUNDO LACHICA JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMUNDO
Middle Name:LACHICA
Last Name:BILLENA
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:5490 BROADWAY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-1675
Mailing Address - Country:US
Mailing Address - Phone:219-887-9549
Mailing Address - Fax:219-887-0355
Practice Address - Street 1:5490 BROADWAY
Practice Address - Street 2:SUITE 106
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-1675
Practice Address - Country:US
Practice Address - Phone:219-887-9549
Practice Address - Fax:219-887-0355
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2010-11-17
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Provider Licenses
StateLicense IDTaxonomies
IN01026067A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INE41091Medicare UPIN
IN458540AMedicare ID - Type Unspecified