Individual
MAHATHI MUDIGONDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
25 CHURCH ST, WILKES BARRE, PA 18765-2151
(570) 808-3410
Mailing address
1458 W CENTER RD STE 1, ESSEXVILLE, MI 48732-2151
(989) 895-4625
(989) 895-4626
Taxonomy
Speciality
Code
Description
License number
State
207QS1201X
Sleep Medicine (Family Medicine) Physician
Primary
OT024405
PA
390200000X
Student in an Organized Health Care Education/Training Program
5151015882
MI
Other
Enumeration date
06/29/2022
Last updated
07/18/2025
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