| NPI | 1215116660 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MALLIKARJUNA R MUKKA Owner 817-624-3500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX L9822) |
| Additional Taxonomies | 207RI0200X Internal Medicine, Infectious Disease |
| Enumeration Date | 2007-11-01 |
| Last Update Date | 2020-01-17 |