Provider Demographics
NPI:1912902198
Name:PALAGIRI, ADIRAJU (MD)
Entity Type:Individual
Prefix:DR
First Name:ADIRAJU
Middle Name:
Last Name:PALAGIRI
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 1:3331 W DEYOUNG ST
Mailing Address - Street 2:STE 105
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5896
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3331 W DEYOUNG ST
Practice Address - Street 2:STE 105
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5896
Practice Address - Country:US
Practice Address - Phone:618-997-8181
Practice Address - Fax:618-997-8499
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D10782Medicare UPIN
ILK19382Medicare PIN