Provider Demographics
NPI:1275505364
Name:VELOUDIS, GEORGE MICHAEL JR (DO)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:MICHAEL
Last Name:VELOUDIS
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 N EAGLE CREEK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-9087
Mailing Address - Country:US
Mailing Address - Phone:859-277-5736
Mailing Address - Fax:859-276-2236
Practice Address - Street 1:170 N EAGLE CREEK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-9087
Practice Address - Country:US
Practice Address - Phone:859-277-5736
Practice Address - Fax:859-276-2236
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2023-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02485207V00000X, 207VE0102X, 207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1275547606Medicaid
KY7100107450Medicaid
KY02485OtherKY LICENSE
KY64024854Medicaid
KY64024854Medicaid
KY02485OtherKY LICENSE
KY7100107450Medicaid