Provider Demographics
NPI:1063409688
Name:VELLEK, MARK J (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:VELLEK
Suffix:
Gender:M
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:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:
Practice Address - Street 1:3131 LA CANADA ST STE 140
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-2579
Practice Address - Country:US
Practice Address - Phone:702-933-9400
Practice Address - Fax:702-933-9444
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYC2194207RH0003X
NV20944207RH0003X
MOR5H89207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
171205OtherHEALTHLINK
106095OtherBCBS OF MO
1210OtherGHP
MO203284625Medicaid
3604003OtherUNITED HEALTHCARE
F19081OtherMERCY HEALTH PLANS
65201A002OtherTRICARE
NV1063409688Medicaid
5132415OtherAETNA
F19081Medicare UPIN
3604003OtherUNITED HEALTHCARE
MO203284625Medicaid