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General NPI Number Information
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NPI Number | 1215116660
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Entity Type | Organization
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Legal Business Name | MALLIKARJUNA MUKKA MD PA
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Dates
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Enumeration Date | 11/01/2007
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 6551 HARRIS PKWY STE 110
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City | FORT WORTH
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State | TX
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Zip | 76132-6105
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Country | US
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Telephone | 817-624-3500
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Fax | 682-708-7225
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Provider Business Mailing Address
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Address Line | 6551 HARRIS PKWY STE 110
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City | FORT WORTH
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State | TX
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Zip | 76132-6105
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Country | US
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Telephone | 817-624-3500
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Fax | 682-708-7225
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Authorized Official
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Title or Position | OWNER
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Name | DR. MALLIKARJUNA R MUKKA
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Credential | MD
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Telephone | 817-624-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | L9822
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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