Organization
INTEGRATED SKIN INSTITUTE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TEJASWI V MUDIGONDA MD (CEO)
(551) 208-3090
Entity
Organization
Contact information
Practice address
1424 W BADDOUR PKWY STE G, LEBANON, TN 37087-2685
(615) 314-1699
(615) 622-8905
Mailing address
1424 W BADDOUR PKWY STE G, LEBANON, TN 37087-2685
(615) 314-1699
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
208200000X
Plastic Surgery Physician
—
—
Other
Enumeration date
12/18/2023
Last updated
04/07/2024
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