Provider Demographics
NPI:1578682464
Name:POLUDASU, RAJA RAM (MD)
Entity Type:Individual
Prefix:
First Name:RAJA RAM
Middle Name:
Last Name:POLUDASU
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 1:1420 RENAISSANCE DR STE 307
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1343
Mailing Address - Country:US
Mailing Address - Phone:847-803-1000
Mailing Address - Fax:847-803-1098
Practice Address - Street 1:1420 RENAISSANCE DR STE 307
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1343
Practice Address - Country:US
Practice Address - Phone:847-803-1000
Practice Address - Fax:847-803-1098
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP53187207UN0902X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy