| Mhya Clinic Pllc | |
|
420 N Kimball Ave Ste 140 Southlake TX 76092-6995 | |
| (817) 583-0575 | |
| Not Available |
| Full Name | Mhya Clinic Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 420 N Kimball Ave Ste 140, Southlake, Texas |
| Authorized Official Name and Position | Haritha Mikkilineni (OWNER) |
| Authorized Official Contact | 8175830575 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mhya Clinic Pllc 420 N Kimball Ave Ste 140 Southlake TX 76092-6995 Ph: (817) 583-0575 | Mhya Clinic Pllc 420 N Kimball Ave Ste 140 Southlake TX 76092-6995 Ph: (817) 583-0575 |
| NPI Number | 1629854690 |
|---|---|
| Provider Enumeration Date | 09/06/2023 |
| Last Update Date | 09/13/2023 |
| Medicare PECOS PAC ID | 6406210806 |
|---|---|
| Medicare Enrollment ID | O20230919002000 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629854690 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Haritha Mikkilineni |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891947438 PECOS PAC ID: 2163584855 Enrollment ID: I20100826001142 |
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