MEDICARE: MARK J VELLEK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	C2194	KY
2	207RH0003X	Hematology & Oncology Physician	20944	NV
3	207RH0003X	Hematology & Oncology Physician	R5H89	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	171205	OTHER	HEALTHLINK
2	106095	OTHER	BCBS OF MO
3	1210	OTHER	GHP
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	3604003	OTHER	UNITED HEALTHCARE
6	F19081	OTHER	MERCY HEALTH PLANS
7	65201A002	OTHER	TRICARE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	5132415	OTHER	AETNA

General Provider Information

NPI Number	:	1063409688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK J VELLEK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 98978
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89193-8978
Country	:	US
Telephone Number	:	702-216-3346
Fax Number	:

Provider Business Practice Location Address
First Line	:	3131 LA CANADA ST STE 140
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-2579
Country	:	US
Telephone Number	:	702-933-9400
Fax Number	:	702-933-9444

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	12/12/2023

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Directions to “ MARK J VELLEK M.D.” Practice Location

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