Provider Demographics
NPI:1255608808
Name:KUNHUNN VELLODY MD
Entity type:Organization
Organization Name:KUNHUNN VELLODY MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDITRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KUNHUNNI
Authorized Official - Middle Name:
Authorized Official - Last Name:VELLODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-229-2764
Mailing Address - Street 1:2850 W 95TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2735
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2850 W 95TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2735
Practice Address - Country:US
Practice Address - Phone:708-229-2764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036046385261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care