Basic Information
Provider Information | |||||||||
NPI: | 1871788927 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MUKAI | ||||||||
FirstName: | AI | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4700 SETON CENTER PKWY | ||||||||
Address2: | SUITE 200 | ||||||||
City: | AUSTIN | ||||||||
State: | TX | ||||||||
PostalCode: | 787595295 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5124391000 | ||||||||
FaxNumber: | 5124391081 | ||||||||
Practice Location | |||||||||
Address1: | 4700 SETON CENTER PKWY | ||||||||
Address2: | SUITE 200 | ||||||||
City: | AUSTIN | ||||||||
State: | TX | ||||||||
PostalCode: | 787595295 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5124391000 | ||||||||
FaxNumber: | 5124391081 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/12/2007 | ||||||||
LastUpdateDate: | 10/30/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/30/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 12549553 | IL | N |   | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |   | 208VP0014X | 12549553 | IL | N |   | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 208100000X | N3195 | TX | Y |   | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |   |
ID Information
ID | Type | State | Issuer | Description | 205552702 | 05 | TX |   | MEDICAID | P00788412 | 01 | TX | MEDICARE RAILROAD | OTHER | 205552701 | 05 | TX |   | MEDICAID |