Provider Demographics
NPI:1558388454
Name:VELLEFF, THOMAS KARL JR (M D)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KARL
Last Name:VELLEFF
Suffix:JR
Gender:M
Credentials:M D
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Other - Credentials:
Mailing Address - Street 1:3150 N WICKHAM RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-2322
Mailing Address - Country:US
Mailing Address - Phone:321-241-6441
Mailing Address - Fax:321-241-6443
Practice Address - Street 1:3150 N WICKHAM RD
Practice Address - Street 2:SUITE 9
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2322
Practice Address - Country:US
Practice Address - Phone:321-241-6441
Practice Address - Fax:321-241-6443
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2019-09-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME42998207QB0002X, 208D00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD82496Medicare UPIN