Individual
DR. RENJITHKUMAR KALIKKOT THEKKEVEEDU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5262
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5262
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
01089483A
IN
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
24321
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07800040
—
MS
Enumeration date
05/03/2012
Last updated
02/22/2023
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