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General NPI Number Information
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NPI Number | 1871579276
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Entity Type | Individual
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Provider Name | BHUSHAN KUKKALLI M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/16/2005
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Last Update Date | 03/09/2010
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Provider Practice Location Address
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Address Line | 6565 FANNIN ST. METHODIST HOSPITAL
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City | HOUSTON
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State | TX
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Zip | 77030
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Country | US
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Telephone | 972-393-1140
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Fax | 972-393-7933
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Provider Business Mailing Address
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Address Line | 5221 PINE ST
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City | BELLAIRE
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State | TX
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Zip | 77401-4820
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Country | US
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Telephone | 713-669-0807
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Fax | 713-669-0807
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | L2391
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License Number State | TX
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