MEDICARE: JAY MUKKER DPM INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)	E46560	CA
2	335E00000X	Prosthetic/Orthotic Supplier	E46560	CA
3	332B00000X	Durable Medical Equipment & Medical Supplies	E46560	CA
4	213ES0103X	Foot & Ankle Surgery Podiatrist	E4656	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962722983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAY MUKKER DPM INC

Provider Business Mailing Address
First Line	:	7210 N MILBURN AVE
Second Line	:	SUITE 101
City	:	FRESNO
State	:	CA
Zip	:	93722-0022
Country	:	US
Telephone Number	:	559-224-5101
Fax Number	:	559-224-4396

Provider Business Practice Location Address
First Line	:	7210 N MILBURN AVE
Second Line	:	SUITE 101
City	:	FRESNO
State	:	CA
Zip	:	93722-0022
Country	:	US
Telephone Number	:	559-224-5101
Fax Number	:	559-224-4396

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAY MUKKER
Credential	:	DPM
Telephone Number	:	559-224-5101

Provider Enumeration Date	:	06/02/2010
Last Update Date	:	06/06/2012

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