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Organization
SOUTHLAKE MHYA PLLC
Active
Organization
SOUTHLAKE MHYA PLLC
Active
Other names
Medrein Health and Aesthetics
Organization subpart
No
Provider details
NPI number
Authorized official
HARITHA MIKKILINENI MD (OWNER)
(817) 583-0575
Entity
Organization
Contact information
Practice address
420 N KIMBALL AVE STE 140, SOUTHLAKE, TX 76092-6995
(817) 583-0575
Mailing address
420 N KIMBALL AVE STE 140, SOUTHLAKE, TX 76092-6995
(817) 583-0575
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
—
—
Other
Enumeration date
04/10/2023
Last updated
09/11/2025
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