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Organization
KSP HEALTH - MO LLC
Active
Organization
KSP HEALTH - MO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MUTHUKUMAR VELLAICHAMY MD (SOLE MEMBER)
(316) 516-2853
Entity
Organization
Contact information
Practice address
117 S LEXINGTON ST STE 100, HARRISONVILLE, MO 64701-2444
(316) 516-2853
Mailing address
6446 E CENTRAL AVE STE 183, WICHITA, KS 67206-1923
(316) 516-2853
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
04/10/2024
Last updated
04/10/2024
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