Provider Demographics
NPI:1083239412
Name:KSPEDIATRICS LLC
Entity Type:Organization
Organization Name:KSPEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUTHUKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:VELLAICHAMY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-516-2853
Mailing Address - Street 1:6446 E CENTRAL AVE
Mailing Address - Street 2:STE 183
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1924
Mailing Address - Country:US
Mailing Address - Phone:316-516-2853
Mailing Address - Fax:
Practice Address - Street 1:6446 E CENTRAL AVE
Practice Address - Street 2:STE 183
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1924
Practice Address - Country:US
Practice Address - Phone:316-516-2853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-11
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty