# KSP HEALTH - MO LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124871074
- **Authorized official:** MUTHUKUMAR VELLAICHAMY MD (SOLE MEMBER)
- **Authorized official phone:** (316) 516-2853

## Contact information

- **Practice address:** 117 S LEXINGTON ST STE 100, HARRISONVILLE, MO 64701-2444
- **Practice address phone:** (316) 516-2853
- **Mailing address:** 6446 E CENTRAL AVE STE 183, WICHITA, KS 67206-1923
- **Mailing address phone:** (316) 516-2853

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/10/2024
- **Last updated:** 04/10/2024