Provider Demographics
NPI:1669689188
Name:VELLORE KIRUBAKARAN M D P A
Entity type:Organization
Organization Name:VELLORE KIRUBAKARAN M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VELLORE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRUBAKARAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-649-5567
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-195822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO25463021OtherBCBSKC
MO202129227Medicaid
KS100115600DMedicaid
MO25463021OtherBCBSKC
KSC52171Medicare UPIN
MO202129227Medicaid
MOX830000AMedicare PIN
KSDG0412Medicare PIN
KSI160000Medicare PIN