Provider Demographics
NPI:1740280312
Name:VELDMAN, MARIE A (DO)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:A
Last Name:VELDMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12701 W 143RD ST
Mailing Address - Street 2:STE 230
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-7715
Mailing Address - Country:US
Mailing Address - Phone:708-301-6702
Mailing Address - Fax:708-301-3421
Practice Address - Street 1:12701 W 143RD ST
Practice Address - Street 2:STE 230
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-7715
Practice Address - Country:US
Practice Address - Phone:708-301-6702
Practice Address - Fax:708-301-3421
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-078204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E36989Medicare UPIN
L86661Medicare ID - Type Unspecified