MEDICARE: VELAZQUEZ CLINIC LTD

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	4532225	OTHER	IL	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1548295108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VELAZQUEZ CLINIC LTD

Provider Business Mailing Address
First Line	:	1185 DUNDEE AVE
Second Line	:	SUITE C
City	:	ELGIN
State	:	IL
Zip	:	60120-2232
Country	:	US
Telephone Number	:	847-931-0300
Fax Number	:	847-931-0303

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	:	847-931-0300
Fax Number	:	847-931-0303

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CARMEN VELAZQUEZ
Credential	:	MD
Telephone Number	:	847-931-0300

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	02/05/2008

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Directions to “VELAZQUEZ CLINIC LTD ” Practice Location

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