Basic Information
| Provider Information | |||||||||
| NPI: | 1700131505 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VELOCCI | ||||||||
| FirstName: | VICTOR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1231 PINE GROVE AVE STE 2A | ||||||||
| Address2: | |||||||||
| City: | PORT HURON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480603500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8109828742 | ||||||||
| FaxNumber: | 8109848291 | ||||||||
| Practice Location | |||||||||
| Address1: | 1231 PINE GROVE AVE STE 2A | ||||||||
| Address2: | |||||||||
| City: | PORT HURON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480603500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8109828742 | ||||||||
| FaxNumber: | 8109848291 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2012 | ||||||||
| LastUpdateDate: | 09/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301100780 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 4301100780 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.