Provider Demographics
NPI:1306933957
Name:THOMAS, TOM MYLAKKAL (DO)
Entity type:Individual
Prefix:
First Name:TOM
Middle Name:MYLAKKAL
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11511 SHADOW CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7298
Mailing Address - Country:US
Mailing Address - Phone:713-442-0000
Mailing Address - Fax:
Practice Address - Street 1:18833 EASTFIELD DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-1305
Practice Address - Country:US
Practice Address - Phone:713-442-4300
Practice Address - Fax:713-442-2705
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9514207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172023701Medicaid
TX172023704Medicaid
TX172023705Medicaid
TX8D3983Medicare PIN
TX172023703Medicaid
TX8D3985Medicare PIN