Healthcare Provider Details

I. General information

NPI: 1235104985
Provider Name (Legal Business Name): SASIDHAR P KILARU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SASHI P KILARU M.D.

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 10/24/2020
Certification Date: 10/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5885 HARRISON AVE
CINCINNATI OH
45248-1691
US

IV. Provider business mailing address

5885 HARRISON AVE
CINCINNATI OH
45248-1691
US

V. Phone/Fax

Practice location:
  • Phone: 513-541-0700
  • Fax: 513-541-2530
Mailing address:
  • Phone: 513-541-0700
  • Fax: 513-541-2530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number37924
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35082964
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35082964
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: