Healthcare Provider Details

I. General information

NPI: 1700131505
Provider Name (Legal Business Name): VICTOR VELOCCI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28963 LITTLE MACK AVE SUITE 101
SAINT CLAIR SHORES MI
48081
US

IV. Provider business mailing address

28963 LITTLE MACK AVE STE 101
SAINT CLAIR SHORES MI
48081-3017
US

V. Phone/Fax

Practice location:
  • Phone: 586-447-0700
  • Fax: 586-447-0795
Mailing address:
  • Phone: 586-447-0700
  • Fax: 586-447-0795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number4301100780
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: