Individual
NIBU JACOB MALAICKAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
REEGT, RPSGT,RNCST
Contact information
Practice address
304 S COPPELL RD, COPPELL, TX 75019-2417
(214) 686-9393
Mailing address
304 S COPPELL RD, COPPELL, TX 75019-2417
(214) 686-9393
Taxonomy
Speciality
Code
Description
License number
State
246ZE0500X
EEG Specialist/Technologist
Primary
4499
—
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
878
—
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
16863
—
273100000X
Epilepsy Hospital Unit
138
—
Other
Enumeration date
11/26/2018
Last updated
11/26/2018
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