Healthcare Provider Details

I. General information

NPI: 1972044113
Provider Name (Legal Business Name): FADDI GHASSAN MOHAMMED SALEH VELEZ M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NE 10TH ST STE 5B
OKLAHOMA CITY OK
73104-5417
US

IV. Provider business mailing address

700 NE 13TH ST # 38
OKLAHOMA CITY OK
73104-5004
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-3635
  • Fax: 405-271-2523
Mailing address:
  • Phone: 405-764-8066
  • Fax: 405-271-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number125.071805
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number38784
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: