Individual
MR. MARIO R VELASCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
210 W MCKINLEY AVE, SUITE 1, DECATUR, IL 62526
(217) 876-6600
(217) 876-6606
Mailing address
210 W MCKINLEY AVE, SUITE 1, DECATUR, IL 62526
(217) 876-6600
(217) 876-6606
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
036104082
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036104082
—
IL
Enumeration date
03/22/2006
Last updated
02/12/2014
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