Provider Demographics
NPI:1376075135
Name:MUKHDOMI, JUNAID (MD)
Entity type:Individual
Prefix:DR
First Name:JUNAID
Middle Name:
Last Name:MUKHDOMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 738247
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-8247
Mailing Address - Country:US
Mailing Address - Phone:614-647-2526
Mailing Address - Fax:877-409-2415
Practice Address - Street 1:5031 FOREST DR STE C
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-7088
Practice Address - Country:US
Practice Address - Phone:614-647-2526
Practice Address - Fax:877-409-2415
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.139030207L00000X, 208VP0014X
IL036.155647208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology