Individual
LUIS M VELASCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
420 N SAWYER RD, KENDALLVILLE, IN 46755-2572
(260) 347-8030
(260) 347-8035
Mailing address
1234 E DUPONT RD, SUITE 1, FORT WAYNE, IN 46825-1545
(260) 373-7854
(260) 458-5664
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
01045543A
IN
207V00000X
Obstetrics & Gynecology Physician
Primary
26945
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000350600
ANTHEM / CMA DBA
KY
01
—
000052153A
HUMANA / CMA DBA
KY
01
—
023334
SIHO / CMA DBA
KY
01
—
1112965
PASSPORT PCP / CMA DBA
KY
01
—
117874
PASSPORT OB/GYN / CMA DBA
KY
01
—
1189995
CHA / CMA DBA
KY
05
—
200005440
—
IN
01
—
2436563000
PASSORT ADVANTAGE OB/GYN / CMA DBA
KY
01
—
2436792000
PASSPORT ADVANTAGE PCP / CMA DBA
KY
01
—
3936751
CIGNA / CMA DBA
KY
05
—
64269459
—
KY
Enumeration date
04/20/2006
Last updated
10/08/2015
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