Provider Demographics
NPI:1922042761
Name:PIDADY, VRUSHALI VINAYAK (MD)
Entity Type:Individual
Prefix:DR
First Name:VRUSHALI
Middle Name:VINAYAK
Last Name:PIDADY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 STATE RD
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-6157
Mailing Address - Country:US
Mailing Address - Phone:608-784-3886
Mailing Address - Fax:
Practice Address - Street 1:2600 STATE RD
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-6157
Practice Address - Country:US
Practice Address - Phone:608-784-3886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine