Provider Demographics
NPI:1386908481
Name:VELASQUEZ, JOHN T (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:VELASQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:707 PRUDDEN ST
Mailing Address - Street 2:APT #204
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-5383
Mailing Address - Country:US
Mailing Address - Phone:908-578-5079
Mailing Address - Fax:
Practice Address - Street 1:1215 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1811
Practice Address - Country:US
Practice Address - Phone:517-364-2583
Practice Address - Fax:517-364-3002
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301101655207P00000X
NJ25MA09705300207P00000X
FLME127402207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine