Provider Demographics
NPI:1164580882
Name:VELIS, DEAN T (MD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:T
Last Name:VELIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:600 W LAKE COOK RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-2085
Mailing Address - Country:US
Mailing Address - Phone:847-459-6495
Mailing Address - Fax:847-459-7929
Practice Address - Street 1:1430 N ARLINGTON HEIGHTS ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4823
Practice Address - Country:US
Practice Address - Phone:847-259-8226
Practice Address - Fax:847-392-5260
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085777207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF97468Medicare UPIN
IL212426Medicare PIN