Individual
DR. TEJASWI VENKATA MUDIGONDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1801 MESQUITE AVE, LAKE HAVASU CITY, AZ 86403-5668
(928) 854-5400
(928) 216-4165
Mailing address
9097 W POST RD STE 100, LAS VEGAS, NV 89148-2417
(928) 854-5400
(928) 216-4165
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
68967
TN
207ND0101X
MOHS-Micrographic Surgery Physician
68967
TN
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
73704
AZ
207ND0900X
Dermatopathology Physician
68967
TN
207NS0135X
Procedural Dermatology Physician
68967
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207R00000X
—
OK
Enumeration date
05/26/2016
Last updated
03/19/2026
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