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NPI Code Detail

MEDICARE: SRIDEVI MUKKAMALA MD

MEDICARE: SRIDEVI MUKKAMALA 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
1208100000XPhysical Medicine & Rehabilitation Physician002389NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18CL085OTHERTXBCBSTX
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4L023895WCPMROTHERWORKERS COMP

General Provider Information

NPI Number : 1982631727
Entity Type Code : Individual
Provider Name (Legal Business Name) : SRIDEVI MUKKAMALA MD
Provider Business Mailing Address
First Line : 909 N WASHINGTON AVE
Second Line : SUITE 115
City : DALLAS
State : TX
Zip : 75246-1520
Country : US
Telephone Number : 214-820-9305
Fax Number : 214-820-9369
Provider Business Practice Location Address
First Line : 909 N WASHINGTON AVE
Second Line : SUITE 115
City : DALLAS
State : TX
Zip : 75246-1520
Country : US
Telephone Number : 214-820-9305
Fax Number : 214-820-9369
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2006
Last Update Date : 06/21/2023

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Directions to “ SRIDEVI MUKKAMALA MD” Practice Location

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