Healthcare Provider Details

I. General information

NPI: 1790081313
Provider Name (Legal Business Name): MARIA KILARI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA HAQUE

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 S 41ST ST
MANITOWOC WI
54220-7316
US

IV. Provider business mailing address

1650 S 41ST ST
MANITOWOC WI
54220-7316
US

V. Phone/Fax

Practice location:
  • Phone: 920-320-2436
  • Fax:
Mailing address:
  • Phone: 920-320-2436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number61545
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number61545
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: