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MUKKAMALLA, HARICHANDANA       
This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.
Practice Address: 855 MONTGOMERY ST 4TH FLOOR
FORTWORTH TX 76107-2553

Address last updated on 9/18/2011
Phone #: (817) 735-3627
Fax #: (817) 735-2673
County: NOT OKLAHOMA
License: 25044
Dated: 10/21/2008
Expires: 10/1/2012
License Type: Medical Doctor
Specialty: Internal Medicine
Status: Inactive
Status Class: Expired License
Restricted to:
Registered to Dispense: YES
Medical School: Kurnool Med Coll, Vijayawada Univ Hlth Sci, Kurnool, AP, India
Graduated: 5 / 2002
CME Year: 2014
Pending and/or Past Disciplinary Actions: No Disciplinary Action Taken.
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Certifications: AMERICAN BOARD OF INTERNAL MEDICINE
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: Hospital(s) Not In Oklahoma
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Locations: Hours: Languages:
855 MONTGOMERY ST 4TH FLOOR
FORTWORTH TX 76107-2553

Phone #: (817) 735-3627
Fax #: (817) 735-2673
Mon: 8:00AM - 5:00PM
Tue: 8:00AM - 5:00PM
Wed: 8:00AM - 5:00PM
Thu: 8:00AM - 5:00PM
Fri: 8:00AM - 5:00PM
Sat:
Sun:

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