Healthcare Provider Details

I. General information

NPI: 1467832634
Provider Name (Legal Business Name): HAKKAPAKKI PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S BECKHAM AVE
TYLER TX
75701-1908
US

IV. Provider business mailing address

3637 RIVER OAKS CT
TYLER TX
75707-1659
US

V. Phone/Fax

Practice location:
  • Phone: 903-597-0351
  • Fax:
Mailing address:
  • Phone: 773-603-8789
  • Fax: 888-242-8720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN9217
License Number StateTX

VIII. Authorized Official

Name: DR. SANTOSH N. HAKKAPAKKI
Title or Position: MD/OWNER
Credential: MD
Phone: 773-603-8789