Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 48690 | KY |
Y | 111NI0900X | Internist | 48690 | KY |
NPI | 1003138918 |
---|---|
Provider Name | Srilakshmi Mukalla |
First Address | Cincinnati, OH 45263-5283 |
Second Address | Crestview Hills, KY 41017-3464 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2010 |
Last Update Date | 19/01/2022 |