Basic Information
| Provider Information | |||||||||
| NPI: | 1063409688 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VELLEK | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 98978 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891938978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022163346 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3131 LA CANADA ST STE 140 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891692579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029339400 | ||||||||
| FaxNumber: | 7029339444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2005 | ||||||||
| LastUpdateDate: | 02/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 20944 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | R5H89 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1063409688 | 05 | NV | MEDICAID | 171205 | 01 | HEALTHLINK | OTHER | 65201A002 | 01 | TRICARE | OTHER | F19081 | 01 | MERCY HEALTH PLANS | OTHER | 5132415 | 01 | AETNA | OTHER | 106095 | 01 | BCBS OF MO | OTHER | 203284625 | 05 | MO | MEDICAID | 1210 | 01 | GHP | OTHER | 3604003 | 01 | UNITED HEALTHCARE | OTHER |