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NPI Code Detail

MEDICARE: DR. TEDDI SWIDINSKY M.D.

MEDICARE:  DR. TEDDI  SWIDINSKY  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery PhysicianMD-2018-0086NM
2208600000XSurgery Physician42110AZ
3208600000XSurgery Physician92292ZZ

General Provider Information

NPI Number : 1578090296
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TEDDI SWIDINSKY M.D.
Provider Business Mailing Address
First Line : 1900 HOT SPRINGS BLVD STE A
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-3480
Country : US
Telephone Number : 505-426-3795
Fax Number :
Provider Business Practice Location Address
First Line : 108 LEGION DR STE B
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-4898
Country : US
Telephone Number : 505-426-3795
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2017
Last Update Date : 12/07/2020

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Directions to “ DR. TEDDI SWIDINSKY M.D.” Practice Location

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