Healthcare Provider Details

I. General information

NPI: 1558388454
Provider Name (Legal Business Name): THOMAS KARL VELLEFF JR. M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 N WICKHAM RD SUITE 9
MELBOURNE FL
32935-2322
US

IV. Provider business mailing address

3150 N WICKHAM RD SUITE 9
MELBOURNE FL
32935-2322
US

V. Phone/Fax

Practice location:
  • Phone: 321-241-6441
  • Fax: 321-241-6443
Mailing address:
  • Phone: 321-241-6441
  • Fax: 321-241-6443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License NumberME42998
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME42998
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME42998
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: