MEDICARE: PRASAD G KILARU

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	2082S0105X	Surgery of the Hand (Plastic Surgery) Physician	A060104	CA
2	208200000X	Plastic Surgery Physician	A060104	CA

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

General Provider Information

NPI Number	:	1689674665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRASAD G KILARU

Provider Business Mailing Address
First Line	:	39141 CIVIC CENTER DR
Second Line	:	SUITE 110
City	:	FREMONT
State	:	CA
Zip	:	94538-1730
Country	:	US
Telephone Number	:	510-791-9700
Fax Number	:	510-791-9703

Provider Business Practice Location Address
First Line	:	39141 CIVIC CENTER DR
Second Line	:	SUITE 110
City	:	FREMONT
State	:	CA
Zip	:	94538-1730
Country	:	US
Telephone Number	:	510-791-9700
Fax Number	:	510-791-9703

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	11/16/2015

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Directions to “ PRASAD G KILARU ” Practice Location

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