Provider Demographics
NPI:1982864476
Name:POLAVARAPU, HARSHA VINEETH (MD)
Entity Type:Individual
Prefix:DR
First Name:HARSHA
Middle Name:VINEETH
Last Name:POLAVARAPU
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 1:927 BROADWAY ST STE 302
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-2727
Mailing Address - Country:US
Mailing Address - Phone:217-224-6423
Mailing Address - Fax:217-214-5819
Practice Address - Street 1:927 BROADWAY ST
Practice Address - Street 2:SUITE 130
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2719
Practice Address - Country:US
Practice Address - Phone:217-224-6423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT189997208600000X
MO2014044161208600000X
IL036132336208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208600000XOtherSURGERY