Provider Demographics
NPI:1952408585
Name:CRESPO-VELEZ, WILFREDO (MD)
Entity Type:Individual
Prefix:DR
First Name:WILFREDO
Middle Name:
Last Name:CRESPO-VELEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WILFREDO
Other - Middle Name:
Other - Last Name:CRESPO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1224 3RD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2354
Mailing Address - Country:US
Mailing Address - Phone:361-854-0201
Mailing Address - Fax:888-465-1315
Practice Address - Street 1:1224 3RD ST STE 1
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2354
Practice Address - Country:US
Practice Address - Phone:361-854-0201
Practice Address - Fax:888-465-1315
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS5346208G00000X
MI4301097707208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY00330231Medicare ID - Type Unspecified