Healthcare Provider Details

I. General information

NPI: 1821245457
Provider Name (Legal Business Name): SUBBARAO POLINENI, M.D. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 JUNGERMANN CIR STE 107
SAINT PETERS MO
63376-1621
US

IV. Provider business mailing address

6 JUNGERMANN CIR STE 107
SAINT PETERS MO
63376-1621
US

V. Phone/Fax

Practice location:
  • Phone: 636-928-1696
  • Fax:
Mailing address:
  • Phone: 636-928-1696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUBBARAO POLINENI
Title or Position: OWNER
Credential: M.D
Phone: 636-928-1696