MEDICARE: DR. YVELICE ANTONIA VILLAMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist		FL

General Provider Information

NPI Number	:	1851339881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YVELICE ANTONIA VILLAMAN MD

Provider Business Mailing Address
First Line	:	7857 NW 192ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33015-2757
Country	:	US
Telephone Number	:	305-469-9718
Fax Number	:	305-857-0653

Provider Business Practice Location Address
First Line	:	17900NW5TH ST 103
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-2809
Country	:	US
Telephone Number	:	954-392-0333
Fax Number	:	954-392-0393

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	08/31/2015

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