Individual
SRIDEVI MUKKAMALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
909 N WASHINGTON AVE, SUITE 115, DALLAS, TX 75246-1520
(214) 820-9305
(214) 820-9369
Mailing address
909 N WASHINGTON AVE, SUITE 115, DALLAS, TX 75246-1520
(214) 820-9305
(214) 820-9369
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
002389
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02673949
—
NY
05
—
217154801
—
TX
01
—
8CL085
BCBSTX
TX
01
—
L023895WCPMR
WORKERS COMP
—
Enumeration date
06/27/2006
Last updated
06/21/2023
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