Provider Demographics
NPI:1477782167
Name:VELUSWAMY, ANGAMMAL N (MD)
Entity Type:Individual
Prefix:
First Name:ANGAMMAL
Middle Name:N
Last Name:VELUSWAMY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 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:
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:248-334-6642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI430110311692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301031169OtherDEA #AV4717027