Provider Demographics
NPI:1497998173
Name:POLIREDDY, RAJENDER REDDY (MD)
Entity Type:Individual
Prefix:
First Name:RAJENDER
Middle Name:REDDY
Last Name:POLIREDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N OAK AVE
Mailing Address - Street 2:MARSHFIELD CLINIC
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-5703
Mailing Address - Country:US
Mailing Address - Phone:715-387-5211
Mailing Address - Fax:
Practice Address - Street 1:1205 O DAY ST
Practice Address - Street 2:MARSHFIELD CLINIC - MERRILL CENTER
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452-3416
Practice Address - Country:US
Practice Address - Phone:715-539-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-11
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.124347207R00000X
WI54478-020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine