Provider Demographics
NPI:1427012004
Name:VELEZ JO, ESTRELLITA (MD)
Entity Type:Individual
Prefix:MRS
First Name:ESTRELLITA
Middle Name:
Last Name:VELEZ JO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10604 SOUTHWEST HIGHWAY
Mailing Address - Street 2:STE 107
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-2717
Mailing Address - Country:US
Mailing Address - Phone:708-422-0636
Mailing Address - Fax:708-424-2164
Practice Address - Street 1:10604 SOUTHWEST HIGHWAY
Practice Address - Street 2:STE 107
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-2717
Practice Address - Country:US
Practice Address - Phone:708-422-0636
Practice Address - Fax:708-424-2164
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105855207RC0200X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632457OtherBLUE CROSS BLUE SHIELD
IL036105855Medicaid
ILP00254382OtherRAILROAD MEDICARE
ILR030131OtherRAILROAD MEDICARE
ILH20749Medicare UPIN
ILK18880Medicare PIN
ILP00254382OtherRAILROAD MEDICARE