Organization
KSP HEALTH LLC
Active
Other names
KS PEDIATRICS
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MUTHUKUMAR VELLAICHAMY MD (OWNER)
(316) 516-2853
Entity
Organization
Contact information
Practice address
7901 4TH ST N STE 300, ST PETERSBURG, FL 33702-4399
(316) 516-2853
Mailing address
6505 E CENTRAL AVE STE 183, WICHITA, KS 67206-1924
(031) 651-6285
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
208000000X
Pediatrics Physician
Primary
—
—
2080P0006X
Developmental - Behavioral Pediatrics Physician
—
—
2080P0202X
Pediatric Cardiology Physician
—
—
2080P0203X
Pediatric Critical Care Medicine Physician
—
—
Other
Enumeration date
05/29/2023
Last updated
05/29/2023
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