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General NPI Number Information
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NPI Number | 1831239748
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Entity Type | Individual
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Provider Name | HARICHANDANA MUKKAMALLA MD
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Gender | Female
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | 2001 N MACARTHUR BLVD STE 520
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City | IRVING
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State | TX
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Zip | 75061-2256
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Country | US
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Telephone | 972-579-8485
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Fax | 972-579-8485
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Provider Business Mailing Address
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Address Line | 2001 N MACARTHUR BLVD SUIT # 520
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City | IRVING
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State | TX
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Zip | 75061-2220
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Country | US
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Telephone | 972-579-8485
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Fax | 972-579-3972
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25044
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | N3914
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License Number State | TX
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