Physician Compare National (NPI:1689122574)

HEALTHCARE PROVIDER: UZOMA I EZEUKA

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1689122574
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2163790882
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200319000122
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	EZEUKA
	Individual professional last name
Provider First Name	UZOMA
	Individual professional first name
Provider Middle Name	IFEYINWA
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2016
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	MALLIKARJUNA MUKKA MD PA
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	9436222510
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	3
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	6551 HARRIS PKWY
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 110
	Group Practice or individual's line 2 address
City	FORT WORTH
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	761326105
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8176243500
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	450779
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST F
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	M