Individual
DR. BASANAGOUD MUDIGOUDAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
848 ADAMS AVE., STE.L400, MEMPHIS, TN 38103
(901) 287-7337
(901) 287-4540
Mailing address
850 POPLAR AVE, BLDG. 2, MEMPHIS, TN 38105
Taxonomy
Speciality
Code
Description
License number
State
2084E0001X
Epilepsy Physician
Primary
48824
TN
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
48824
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163872802
—
TX
05
—
169935701
—
TX
Enumeration date
05/23/2007
Last updated
05/19/2023
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