Active NPI
Leenu Mary Pallickal, M.D.
- Neurology Physician
- Austin, TX
National Provider Identifier
1962681841
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- BP10029779
- Practice address
- 601 E 15TH St
Brack Annex Neurology Department
Austin, TX 78701-1930 - Phone
- (512) 324-7000
- Fax
- (512) 324-8933
- NPI assigned
- Oct 29, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | BP10029779 | TX | Primary |
Addresses
Primary practice location
601 E 15TH St
Brack Annex Neurology Department
Austin, TX 78701-1930
Mailing address
5800 Brodie LN
Apt. 534
Austin, TX 78745-2557
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BP10029779 | TX | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193616000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193616000000",
"number": "1962681841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5800 BRODIE LN",
"address_2": "APT. 534",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787452557"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 E 15TH ST",
"address_2": "BRACK ANNEX NEUROLOGY DEPARTMENT",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787011930",
"telephone_number": "512-324-7000",
"fax_number": "512-324-8933"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PALLICKAL",
"first_name": "LEENU",
"middle_name": "MARY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-10-29",
"last_updated": "2007-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "TX",
"license": "BP10029779",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.