Healthcare Provider Details

I. General information

NPI: 1972182533
Provider Name (Legal Business Name): MICHAEL R VELEZ MD, MTM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3548 TIMBERVIEW RD
POWHATAN VA
23139-4200
US

IV. Provider business mailing address

3548 TIMBERVIEW RD
POWHATAN VA
23139-4200
US

V. Phone/Fax

Practice location:
  • Phone: 804-337-9820
  • Fax: 804-220-1690
Mailing address:
  • Phone: 305-699-2551
  • Fax: 804-220-1690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME167122
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101281685
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberD0101859
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA193111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: