MEDICARE: LATHA VELUSAMY M.D.

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	207RN0300X	Nephrology Physician	M6438	TX

General Provider Information

NPI Number	:	1710986013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATHA VELUSAMY M.D.

Provider Business Mailing Address
First Line	:	3571 W WHEATLAND RD
Second Line	:	STE 101
City	:	DALLAS
State	:	TX
Zip	:	75237-3461
Country	:	US
Telephone Number	:	972-274-5555
Fax Number	:	972-274-5663

Provider Business Practice Location Address
First Line	:	3571 W WHEATLAND RD
Second Line	:	STE 101
City	:	DALLAS
State	:	TX
Zip	:	75237-3461
Country	:	US
Telephone Number	:	972-274-5555
Fax Number	:	972-274-5663

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	03/13/2015

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