MEDICARE: DR. SASIDHAR P KILARU M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	37924	KY
2	208600000X	Surgery Physician	35082964	OH
3	2086S0129X	Vascular Surgery Physician	35082964	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00058512	OTHER	OH	RAILROAD MEDICARE
5	P00173109	OTHER	OH	RR MEDICARE
6	P00629656	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235104985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SASIDHAR P KILARU M.D.

Provider Business Mailing Address
First Line	:	5885 HARRISON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45248-1691
Country	:	US
Telephone Number	:	513-541-0700
Fax Number	:	513-541-2530

Provider Business Practice Location Address
First Line	:	5885 HARRISON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45248-1691
Country	:	US
Telephone Number	:	513-541-0700
Fax Number	:	513-541-2530

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	10/24/2020

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Directions to “ DR. SASIDHAR P KILARU M.D.” Practice Location

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