Healthcare Provider Details

I. General information

NPI: 1992793244
Provider Name (Legal Business Name): PLAKKAT K VELAYUDHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6707 POWERS BLVD STE 309
PARMA OH
44129-5466
US

IV. Provider business mailing address

6707 POWERS BLVD STE 309
PARMA OH
44129-5466
US

V. Phone/Fax

Practice location:
  • Phone: 440-886-5558
  • Fax: 440-886-4540
Mailing address:
  • Phone: 440-886-5558
  • Fax: 440-886-4540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number40520
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: