MEDICARE: CARMEN VELAZQUEZ 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	207R00000X	Internal Medicine Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04532225	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1518965714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN VELAZQUEZ MD

Provider Business Mailing Address
First Line	:	1185 DUNDEE AVE
Second Line	:	SUITE C
City	:	ELGIN
State	:	IL
Zip	:	60120-2232
Country	:	US
Telephone Number	:	847-931-0303
Fax Number	:	847-931-5230

Provider Business Practice Location Address
First Line	:	1185 DUNDEE AVE
Second Line	:	SUITE C
City	:	ELGIN
State	:	IL
Zip	:	60120-2232
Country	:	US
Telephone Number	:	847-931-0303
Fax Number	:	847-931-5230

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	02/05/2008

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Directions to “ CARMEN VELAZQUEZ MD” Practice Location

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