Basic Information
| Provider Information | |||||||||
| NPI: | 1962752899 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VILLAFANE | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | LAB TECHNICIAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9243 S ROBERTS RD | ||||||||
| Address2: | 2R | ||||||||
| City: | HICKORY HILLS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604572079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089075694 | ||||||||
| FaxNumber: | 7737512250 | ||||||||
| Practice Location | |||||||||
| Address1: | 9243 S ROBERTS RD | ||||||||
| Address2: | 2R | ||||||||
| City: | HICKORY HILLS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604572079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089075694 | ||||||||
| FaxNumber: | 7737512250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2012 | ||||||||
| LastUpdateDate: | 09/18/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246R00000X | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Pathology |
No ID Information.