Healthcare Provider Details

I. General information

NPI: 1356623821
Provider Name (Legal Business Name): ALAGARRAJU MUTHUKUMAR PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2011
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 HARRY HINES BLVD., DEPARTMENT OF PATHOLOGY, STE CS 3.114
DALLAS TX
75390-9073
US

IV. Provider business mailing address

5323 HARRY HINES BLVD., DEPARTMENT OF PATHOLOGY, STE CS 3.114
DALLAS TX
75390-9073
US

V. Phone/Fax

Practice location:
  • Phone: 214-648-8444
  • Fax: 214-648-8037
Mailing address:
  • Phone: 214-648-8444
  • Fax: 214-648-8037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: