Provider Demographics
NPI:1902428485
Name:VELOSO, ROBERTO MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:MARTIN
Last Name:VELOSO
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 1:4201 ST. ANTOINE
Mailing Address - Street 2:UHC 9C
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-966-0463
Mailing Address - Fax:313-993-8501
Practice Address - Street 1:4201 ST. ANTOINE
Practice Address - Street 2:UHC 9C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-966-0463
Practice Address - Fax:313-993-8501
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-07
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program