Provider Demographics
NPI:1649506403
Name:VELASCO, FE A (MD)
Entity type:Individual
Prefix:
First Name:FE
Middle Name:A
Last Name:VELASCO
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 1:1340 REMINGTON RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4830
Mailing Address - Country:US
Mailing Address - Phone:847-882-8908
Mailing Address - Fax:
Practice Address - Street 1:1340 REMINGTON RD
Practice Address - Street 2:SUITE K
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4830
Practice Address - Country:US
Practice Address - Phone:847-882-8908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2009-11-02
Deactivation Date:2009-09-14
Deactivation Code:
Reactivation Date:2009-10-28
Provider Licenses
StateLicense IDTaxonomies
IL0360657502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036065750Medicaid
ILL83933Medicare UPIN
IL036065750Medicaid