Provider Demographics
NPI:1205979515
Name:VELASCO, MAXIMILIANO (MD)
Entity type:Individual
Prefix:DR
First Name:MAXIMILIANO
Middle Name:
Last Name:VELASCO
Suffix:
Gender:M
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:PO BOX 430885
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33243-0885
Mailing Address - Country:US
Mailing Address - Phone:786-456-4107
Mailing Address - Fax:786-376-8908
Practice Address - Street 1:10095 N KENDALL DR STE 103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176
Practice Address - Country:US
Practice Address - Phone:786-504-0904
Practice Address - Fax:786-504-0899
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95957207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL316159OtherAVMED
FLAD7710ZMedicare UPIN