Provider Demographics
NPI:1043225642
Name:VELUSWAMY, VARUDEYAM P (MD)
Entity Type:Individual
Prefix:
First Name:VARUDEYAM
Middle Name:P
Last Name:VELUSWAMY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:V
Other - Middle Name:P
Other - Last Name:VELUSWAMY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD,
Mailing Address - Street 1:2150 SHORE HILL DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-1962
Mailing Address - Country:US
Mailing Address - Phone:248-334-6642
Mailing Address - Fax:248-334-6433
Practice Address - Street 1:2150 SHORE HILL DR
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-1962
Practice Address - Country:US
Practice Address - Phone:941-232-9448
Practice Address - Fax:941-383-4249
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL8076452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301031168OtherSTATE OF MICHIGAN. DEPARTMENT OF COMMUNITY HEALTH