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NPI Code Detail

MEDICARE: DR. JOSE NELLIKAPPALLIL MD

MEDICARE: DR. JOSE NELLIKAPPALLIL MD
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
1207P00000XEmergency Medicine PhysicianV2180TX
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1124777255
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSE NELLIKAPPALLIL MD
Provider Business Mailing Address
First Line : 1500 S MAIN ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4917
Country : US
Telephone Number : 817-702-8840
Fax Number :
Provider Business Practice Location Address
First Line : 1500 S MAIN ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4917
Country : US
Telephone Number : 817-702-8840
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2022
Last Update Date : 01/28/2026

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