Organization
TAMPA INSTITUTE FOR PAIN AND SPINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSEN MUKALEL M.D. (PRESIDENT)
(813) 513-8477
Entity
Organization
Contact information
Practice address
13140 ELK MOUNTAIN DR, SUITE B, RIVERVIEW, FL 33579
(813) 513-8477
Mailing address
13140 ELK MOUNTAIN DR, SUITE B, RIVERVIEW, FL 33579-7182
(813) 513-8477
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
2084N0400X
Neurology Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18353700
—
FL
Enumeration date
07/01/2016
Last updated
07/31/2018
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