| Doctor Name: | MR. RICHARD JOHN ABAIS VILLACERAN |
| NPI Number: | 1245649862 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 209.011672 |
| Business Practice Address: | 431 W Liberty St Wauconda, IL - 600842452 |
| Business Phone Number: | 8475262151 |
| Business Fax Number: | |
| Mailing Address: | 6 Haddon Ct, LAKE IN THE HILLS |
| State: | IL |
| Postal Code: | 60156 |
| Phone Number: | 8475262151 |
| Fax Number: | |
| NPI Enumeration Date: | 08/07/2014 |
| NPI Last Update Date: | 08/07/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 209.011672 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |