Provider Demographics
NPI:1518965714
Name:VELAZQUEZ, CARMEN (MD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:VELAZQUEZ
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 1:1185 DUNDEE AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-2232
Mailing Address - Country:US
Mailing Address - Phone:847-931-0303
Mailing Address - Fax:847-931-5230
Practice Address - Street 1:1185 DUNDEE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-2232
Practice Address - Country:US
Practice Address - Phone:847-931-0303
Practice Address - Fax:847-931-5230
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04532225OtherBLUE CROSS BLUE SHIELD
ILK14530Medicare PIN
IL04532225OtherBLUE CROSS BLUE SHIELD