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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