Provider Demographics
NPI:1780225144
Name:MD ANESTHESIA PLLC
Entity Type:Organization
Organization Name:MD ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JESSEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MUKALEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-390-7697
Mailing Address - Street 1:3004 COMMUNICATIONS PKWY STE 200-163
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8909
Mailing Address - Country:US
Mailing Address - Phone:121-439-0769
Mailing Address - Fax:972-432-6692
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:214-390-7697
Practice Address - Fax:972-432-6692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty