Organization
TAMPA INSTITUTE FOR PAIN AND SPINE, LLC
Active
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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