Provider Demographics
NPI:1619009172
Name:KIRUBAKARAN, VELLORE (MD)
Entity Type:Individual
Prefix:
First Name:VELLORE
Middle Name:
Last Name:KIRUBAKARAN
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:PO BOX 27127
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66225-7127
Mailing Address - Country:US
Mailing Address - Phone:913-649-5567
Mailing Address - Fax:913-649-7563
Practice Address - Street 1:4121 W 83RD ST
Practice Address - Street 2:SUITE 254
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-5300
Practice Address - Country:US
Practice Address - Phone:913-649-5567
Practice Address - Fax:913-649-7563
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-195822084P0800X
MO358242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS11476056OtherBLUE SHIELD KANSAS CITY
MO202129227Medicaid
260036797OtherRAILROAD MEDICARE
KS11476046OtherBCBS PROVIDER #
KS100115600DMedicaid
KS632223OtherBLUE SHIELD KANSAS
KS106753Medicare PIN
KS11476056OtherBLUE SHIELD KANSAS CITY
KSI165294Medicare PIN
260036797OtherRAILROAD MEDICARE
KS11476046OtherBCBS PROVIDER #
KS260036797Medicare PIN