Healthcare Provider Details

I. General information

NPI: 1700042017
Provider Name (Legal Business Name): MALLIKARJUN BADIGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MALLIKARJUN PUNDLEEK BADIGER MD

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 33100 BOX LANDSTUHL
APO AE
09180-3100
US

IV. Provider business mailing address

CMR 402 BOX 129
APO AE
09180-1002
US

V. Phone/Fax

Practice location:
  • Phone: 314-541-5535
  • Fax:
Mailing address:
  • Phone: 314-541-5535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberP1845
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: