Provider Demographics
NPI:1821245457
Name:SUBBARAO POLINENI, M.D. PC
Entity Type:Organization
Organization Name:SUBBARAO POLINENI, M.D. PC
Other - Org Name:SUBBARAO POLINENI, M.D
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUBBARAO
Authorized Official - Middle Name:
Authorized Official - Last Name:POLINENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-928-1696
Mailing Address - Street 1:6 JUNGERMANN CIR
Mailing Address - Street 2:STE 107
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1621
Mailing Address - Country:US
Mailing Address - Phone:636-928-1696
Mailing Address - Fax:
Practice Address - Street 1:6 JUNGERMANN CIR
Practice Address - Street 2:STE 107
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1621
Practice Address - Country:US
Practice Address - Phone:636-928-1696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1293740002Medicare NSC