Healthcare Provider Details

I. General information

NPI: 1275505364
Provider Name (Legal Business Name): GEORGE MICHAEL VELOUDIS JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3292 EAGLE VIEW LN STE 190
LEXINGTON KY
40509-2173
US

IV. Provider business mailing address

PO BOX 55069
LEXINGTON KY
40555-5069
US

V. Phone/Fax

Practice location:
  • Phone: 859-277-5736
  • Fax: 859-276-2236
Mailing address:
  • Phone: 859-277-5736
  • Fax: 859-276-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number02485
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number02485
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02485
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number02485
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: