Healthcare Provider Details

I. General information

NPI: 1912502139
Provider Name (Legal Business Name): DMEMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3786 FM 1488 RD STE 150
CONROE TX
77384-4987
US

IV. Provider business mailing address

400 STONEBROOK PKWY STE 1104-211
FRISCO TX
75036-1179
US

V. Phone/Fax

Practice location:
  • Phone: 214-390-7697
  • Fax: 214-432-6692
Mailing address:
  • Phone: 214-390-7697
  • Fax: 972-432-6692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JESSEN MUKALEL
Title or Position: ADMIN
Credential: MD
Phone: 214-390-7697