Provider Demographics
NPI:1487972279
Name:MADHURI SEGIREDDY MD PC
Entity type:Organization
Organization Name:MADHURI SEGIREDDY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MADHURI
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGIREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-202-6660
Mailing Address - Street 1:4022 E PRESIDIO ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1113
Mailing Address - Country:US
Mailing Address - Phone:480-985-1093
Mailing Address - Fax:480-296-7643
Practice Address - Street 1:485 S DOBSON RD
Practice Address - Street 2:SUITE 105
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5602
Practice Address - Country:US
Practice Address - Phone:480-855-0421
Practice Address - Fax:480-855-0467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ438501Medicaid