Healthcare Provider Details

I. General information

NPI: 1568690865
Provider Name (Legal Business Name): DR. SURYA NARAYAN MULUKUTLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 MICHAELANGELO DR STE 102B
EDINBURG TX
78539-1411
US

IV. Provider business mailing address

PO BOX 2646
MCALLEN TX
78502-2646
US

V. Phone/Fax

Practice location:
  • Phone: 956-362-5650
  • Fax: 956-362-2599
Mailing address:
  • Phone: 956-362-5650
  • Fax: 956-362-2599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberP4683
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberP4683
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: