Provider Demographics
NPI:1285993832
Name:PULIKAL, ADITYA BHASKAR (MD, JD)
Entity type:Individual
Prefix:
First Name:ADITYA
Middle Name:BHASKAR
Last Name:PULIKAL
Suffix:
Gender:
Credentials:MD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 CAT HOLLOW DR STE 203
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5799
Mailing Address - Country:US
Mailing Address - Phone:512-734-8060
Mailing Address - Fax:512-859-6684
Practice Address - Street 1:511 OAKWOOD BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4068
Practice Address - Country:US
Practice Address - Phone:512-734-8060
Practice Address - Fax:512-859-6684
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT27242084P0800X, 2084P2900X, 208VP0000X, 208VP0000X
MO2018030100208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200059211Medicaid