Individual
BHUSHAN KUKKALLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6565 FANNIN ST., METHODIST HOSPITAL, HOUSTON, TX 77030
(972) 393-1140
(972) 393-7933
Mailing address
5221 PINE ST, BELLAIRE, TX 77401-4820
(713) 669-0807
(713) 669-0807
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
L2391
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148071703
—
TX
05
—
148071705
—
TX
01
—
8F8317
BCBSTX PROV NO
TX
Enumeration date
12/16/2005
Last updated
03/09/2010
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