Healthcare Provider Details

I. General information

NPI: 1699732156
Provider Name (Legal Business Name): JAGPREET MUKKER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7210 N MILBURN AVE STE 101
FRESNO CA
93722-8449
US

IV. Provider business mailing address

7210 N MILBURN AVE STE 101
FRESNO CA
93722-8449
US

V. Phone/Fax

Practice location:
  • Phone: 559-224-5101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4656
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: