Provider Demographics
NPI:1336397280
Name:MUKALEL, JESSEN JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:JESSEN
Middle Name:JAMES
Last Name:MUKALEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3786 FM 1488 RD STE 150
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4987
Mailing Address - Country:US
Mailing Address - Phone:346-272-0025
Mailing Address - Fax:281-781-2540
Practice Address - Street 1:3786 FM 1488 RD STE 150
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-4987
Practice Address - Country:US
Practice Address - Phone:773-454-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0257207LP2900X, 208VP0014X
FLME111197208VP0014X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FM008664100Medicaid
FL18353700Medicaid
FL18353700Medicaid
FLHF901PMedicare PIN