Healthcare Provider Details

I. General information

NPI: 1003910423
Provider Name (Legal Business Name): PRASAD K. KILARU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 N ROCKTON AVE
ROCKFORD IL
61103-3600
US

IV. Provider business mailing address

2350 N ROCKTON AVE
ROCKFORD IL
61103-3600
US

V. Phone/Fax

Practice location:
  • Phone: 815-971-2000
  • Fax:
Mailing address:
  • Phone: 815-971-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number036081608
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036-081608
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number036081608
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: