Healthcare Provider Details

I. General information

NPI: 1649506403
Provider Name (Legal Business Name): FE A. VELASCO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date: 09/14/2009
Reactivation Date: 10/28/2009

III. Provider practice location address

1340 REMINGTON RD SUITE K
SCHAUMBURG IL
60173-4830
US

IV. Provider business mailing address

1340 REMINGTON RD SUITE K
SCHAUMBURG IL
60173-4830
US

V. Phone/Fax

Practice location:
  • Phone: 847-882-8908
  • Fax:
Mailing address:
  • Phone: 847-882-8908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036065750
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: