Provider Demographics
NPI:1316529407
Name:PALURI, MOUCTIKA LAKSHMI (MD)
Entity type:Individual
Prefix:DR
First Name:MOUCTIKA
Middle Name:LAKSHMI
Last Name:PALURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:LAKSHMI
Other - Middle Name:MOUCTIKA
Other - Last Name:PALURI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 661247
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-1247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2704 N GALLOWAY AVE STE 103
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6379
Practice Address - Country:US
Practice Address - Phone:214-660-2500
Practice Address - Fax:833-535-1076
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
TXV4958207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program