Provider Demographics
NPI:1588787576
Name:R. L. BILLENA MEDICAL CORPORATION
Entity type:Organization
Organization Name:R. L. BILLENA MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMUNDO
Authorized Official - Middle Name:LACHICA
Authorized Official - Last Name:BILLENA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:219-887-9549
Mailing Address - Street 1:5490 BROADWAY
Mailing Address - Street 2:
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:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN458540Medicare ID - Type UnspecifiedGROUP