| Luis M Velasco, MD | |
|
420 N Sawyer Rd, Kendallville, IN 46755-2572 | |
| (260) 347-8030 | |
| (260) 347-8035 |
| Full Name | Luis M Velasco |
|---|---|
| Gender | Male |
| Speciality | Obstetrics & Gynecology |
| Location | 420 N Sawyer Rd, Kendallville, Indiana |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093770992 | NPI | - | NPPES |
| 117874 | Other | KY | PASSPORT OB/GYN / CMA DBA |
| 3936751 | Other | KY | CIGNA / CMA DBA |
| 000052153A | Other | KY | HUMANA / CMA DBA |
| 1112965 | Other | KY | PASSPORT PCP / CMA DBA |
| 64269459 | Medicaid | KY | |
| 000000350600 | Other | KY | ANTHEM / CMA DBA |
| 023334 | Other | KY | SIHO / CMA DBA |
| 200005440 | Medicaid | IN | |
| 1189995 | Other | KY | CHA / CMA DBA |
| 2436563000 | Other | KY | PASSORT ADVANTAGE OB/GYN / CMA DBA |
| 2436792000 | Other | KY | PASSPORT ADVANTAGE PCP / CMA DBA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207V00000X | Obstetrics & Gynecology | 26945 (Kentucky) | Primary |
| 207V00000X | Obstetrics & Gynecology | 01045543A (Indiana) | Secondary |
| Entity Name | Midwest Dysphagia Consultants Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1639404171 PECOS PAC ID: 8820360795 Enrollment ID: O20180213001890 |
| Mailing Address | Practice Location Address |
|---|---|
| Luis M Velasco, MD 1234 E Dupont Rd, Suite 1, Fort Wayne, IN 46825-1545 Ph: (260) 373-7854 | Luis M Velasco, MD 420 N Sawyer Rd, Kendallville, IN 46755-2572 Ph: (260) 347-8030 |
Rhonda Miller, MD Obstetrics & Gynecology Medicare: Accepting Medicare Assignments Practice Location: 420 N Sawyer Rd, Kendallville, IN 46755 Phone: 260-347-8030 Fax: 260-347-8035 | |
Bobby Tolosa, MD Obstetrics & Gynecology Medicare: Accepting Medicare Assignments Practice Location: 420 N Sawyer Rd, Kendallville, IN 46755 Phone: 260-347-8030 Fax: 260-347-8035 | |
Kiersa Diane Durfee, MD Obstetrics & Gynecology Medicare: Medicare Enrolled Practice Location: 420 N Sawyer Rd, Kendallville, IN 46755 Phone: 260-347-8030 Fax: 260-347-8035 |