Provider Demographics
NPI:1659510337
Name:YELLU, MAHENDER REDDY (MD)
Entity Type:Individual
Prefix:
First Name:MAHENDER
Middle Name:REDDY
Last Name:YELLU
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 1:4371 VERONICA S SHOEMAKER BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2216
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:1396 WHISPER CIR
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1204
Practice Address - Country:US
Practice Address - Phone:863-385-1244
Practice Address - Fax:863-385-6086
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI53779-20207R00000X
OH35-121453207R00000X
FLME137058207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100006909Medicaid
WI360450080Medicare PIN
WI100006909Medicaid
WI002380306Medicare PIN