Provider Demographics
NPI:1881702470
Name:MIKKILINENI, RAJYALAKSHMI (MD)
Entity type:Individual
Prefix:
First Name:RAJYALAKSHMI
Middle Name:
Last Name:MIKKILINENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 E MULBERRY ROAD
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515
Mailing Address - Country:US
Mailing Address - Phone:979-849-2777
Mailing Address - Fax:979-849-8090
Practice Address - Street 1:2020 E MULBERRY ROAD
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515
Practice Address - Country:US
Practice Address - Phone:979-849-2777
Practice Address - Fax:979-849-8090
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0483207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120570003Medicaid
TX00R47VMedicare ID - Type Unspecified
C19366Medicare UPIN