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1073559159

NPI Code Detail

MEDICARE: DR. DOMINIC MALIAKKAL JOSEPH MDPA

MEDICARE: DR. DOMINIC MALIAKKAL JOSEPH MDPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	J1278	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	260044914	OTHER	TX	RAIL ROAD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	260044915	OTHER	TX	RAIL ROAD
6	89406S	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1073559159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOMINIC MALIAKKAL JOSEPH MDPA

Provider Business Mailing Address
First Line	:	2026 VALLERIA CT
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-5568
Country	:	US
Telephone Number	:	281-265-8056
Fax Number	:

Provider Business Practice Location Address
First Line	:	9401 SOUTHWEST FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1407
Country	:	US
Telephone Number	:	713-970-3354
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	10/19/2020

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Directions to “ DR. DOMINIC MALIAKKAL JOSEPH MDPA” Practice Location

Language	Start Address	Practice Location

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