Healthcare Provider Details

I. General information

NPI: 1265432611
Provider Name (Legal Business Name): MUTHUSAMY VELUSAMY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MUTHU VELUSAMY MD

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6328 GUNN HWY STE C SUITE C
TAMPA FL
33625-4101
US

IV. Provider business mailing address

6328 GUNN HWY STE C SUITE C
TAMPA FL
33625-4101
US

V. Phone/Fax

Practice location:
  • Phone: 813-610-9510
  • Fax: 813-304-0275
Mailing address:
  • Phone: 813-610-9510
  • Fax: 813-304-0275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME85317
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME85317
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberME85317
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: