Healthcare Provider Details

I. General information

NPI: 1083613764
Provider Name (Legal Business Name): RAMESH CHANDRA KILARU M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 MEADOWOOD LN
BLOOMFIELD MI
48302-1031
US

IV. Provider business mailing address

100 W KIRBY ST
DETROIT MI
48202-4044
US

V. Phone/Fax

Practice location:
  • Phone: 313-585-8646
  • Fax: 248-731-8571
Mailing address:
  • Phone: 313-585-8646
  • Fax: 248-731-8571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301060436
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: