Provider Demographics
NPI:1265432611
Name:VELUSAMY, MUTHUSAMY (MD)
Entity type:Individual
Prefix:DR
First Name:MUTHUSAMY
Middle Name:
Last Name:VELUSAMY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MUTHU
Other - Middle Name:
Other - Last Name:VELUSAMY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6328 GUNN HWY STE C
Mailing Address - Street 2:SUITE C
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-4101
Mailing Address - Country:US
Mailing Address - Phone:813-610-9510
Mailing Address - Fax:813-304-0275
Practice Address - Street 1:6328 GUNN HWY STE C
Practice Address - Street 2:SUITE C
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-4101
Practice Address - Country:US
Practice Address - Phone:813-610-9510
Practice Address - Fax:813-304-0275
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85317207RC0000X, 207RI0011X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009940965Medicaid
FLG40226Medicare UPIN
372136OtherAVMED
FL2646358 00Medicaid
FL203609OtherWELLCARE
3559089OtherGHI
FLP01356954OtherRAILROAD MCR
FL17488ZMedicare PIN
FL17488YMedicare PIN
FL17488OtherBCBS