MEDICARE: DR. MUTHUSAMY VELUSAMY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	ME85317	FL
2	207RI0011X	Interventional Cardiology Physician	ME85317	FL
3	207UN0901X	Nuclear Cardiology Physician	ME85317	FL

General Provider Information

NPI Number	:	1265432611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MUTHUSAMY VELUSAMY MD

Provider Business Mailing Address
First Line	:	6328 GUNN HWY STE C
Second Line	:	SUITE C
City	:	TAMPA
State	:	FL
Zip	:	33625-4101
Country	:	US
Telephone Number	:	813-610-9510
Fax Number	:	813-304-0275

Provider Business Practice Location Address
First Line	:	6328 GUNN HWY STE C
Second Line	:	SUITE C
City	:	TAMPA
State	:	FL
Zip	:	33625-4101
Country	:	US
Telephone Number	:	813-610-9510
Fax Number	:	813-304-0275

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/23/2020

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