Healthcare Provider Details

I. General information

NPI: 1669689188
Provider Name (Legal Business Name): VELLORE KIRUBAKARAN M D P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 W 83RD ST SUITE 254
PRAIRIE VILLAGE KS
66208-5300
US

IV. Provider business mailing address

PO BOX 27127
OVERLAND PARK KS
66225-7127
US

V. Phone/Fax

Practice location:
  • Phone: 913-649-5567
  • Fax: 913-649-7563
Mailing address:
  • Phone: 913-649-5567
  • Fax: 913-649-7563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number04-19582
License Number StateKS

VIII. Authorized Official

Name: VELLORE KIRUBAKARAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 913-649-5567