Provider Demographics
NPI:1225066129
Name:VELLODY, KUNHUNNI (MD)
Entity Type:Individual
Prefix:DR
First Name:KUNHUNNI
Middle Name:
Last Name:VELLODY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 W 95TH STREET
Mailing Address - Street 2:SUITE 203
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2734
Mailing Address - Country:US
Mailing Address - Phone:708-229-2764
Mailing Address - Fax:708-229-2766
Practice Address - Street 1:2850 W 95TH STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2734
Practice Address - Country:US
Practice Address - Phone:708-229-2764
Practice Address - Fax:708-229-2766
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21603948OtherBLUE CROSS
IL21603948OtherBLUE CROSS
398830Medicare ID - Type Unspecified