Healthcare Provider Details

I. General information

NPI: 1134822232
Provider Name (Legal Business Name): JOSE ANTONIO VELEZ II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S WOOD ST
CHICAGO IL
60612-4325
US

IV. Provider business mailing address

250 SW 48TH LN
OCALA FL
34471-8453
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-6043
  • Fax:
Mailing address:
  • Phone: 352-209-7374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1134822232
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: