Organization
KSP HEALTH - NEW MEXICO LLC
Active
Organization
KSP HEALTH - NEW MEXICO LLC
Active
Other names
KSP HEALTH - NEW MEXICO LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MUTHUKUMAR VELLAICHAMY MD (OWNER)
(234) 260-6212
Entity
Organization
Contact information
Practice address
2201 MENAUL BLVD NE STE A, ALBUQUERQUE, NM 87107-1711
(234) 260-6212
Mailing address
6446 E CENTRAL AVE STE 183, WICHITA, KS 67206-1923
(234) 260-6212
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
—
—
207NP0225X
Pediatric Dermatology Physician
—
—
208000000X
Pediatrics Physician
Primary
—
—
2080P0006X
Developmental - Behavioral Pediatrics Physician
—
—
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
—
—
2080P0201X
Pediatric Allergy/Immunology Physician
—
—
2080P0202X
Pediatric Cardiology Physician
—
—
2080P0203X
Pediatric Critical Care Medicine Physician
—
—
2080P0205X
Pediatric Endocrinology Physician
—
—
2080P0206X
Pediatric Gastroenterology Physician
—
—
2080P0207X
Pediatric Hematology & Oncology Physician
—
—
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
—
—
Other
Enumeration date
10/06/2023
Last updated
10/06/2023
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