Healthcare Provider Details

I. General information

NPI: 1508823097
Provider Name (Legal Business Name): RAVI KUMAR KILARU M.B.B.S, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 HEMLOCK ST
BREMERTON WA
98310-2623
US

IV. Provider business mailing address

2709 HEMLOCK ST
BREMERTON WA
98310-2623
US

V. Phone/Fax

Practice location:
  • Phone: 360-782-6000
  • Fax: 253-835-8869
Mailing address:
  • Phone: 360-782-6000
  • Fax: 253-835-8869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMD60294736
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number4301099665
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD60294736
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: