Individual
HARICHANDANA MUKKAMALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2001 N MACARTHUR BLVD STE 520, IRVING, TX 75061-2256
(972) 579-8485
(972) 579-8485
Mailing address
2001 N MACARTHUR BLVD SUIT # 520, IRVING, TX 75061-2220
(972) 579-8485
(972) 579-3972
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25044
OK
207R00000X
Internal Medicine Physician
Primary
N3914
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207496501
—
TX
01
—
8CL897
BCBS
TX
01
—
P00929178
RAILROAD MEDICARE
TX
Enumeration date
02/08/2007
Last updated
04/06/2022
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