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General NPI Number Information
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NPI Number | 1376974345
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Entity Type | Organization
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Legal Business Name | DEEPIKA KILARU MD PA
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Dates
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Enumeration Date | 12/02/2013
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Last Update Date | 02/17/2023
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Provider Practice Location Address
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Address Line | 4100 HERITAGE AVE STE 106
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City | GRAPEVINE
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State | TX
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Zip | 76051-5716
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Country | US
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Telephone | 214-455-0579
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 E SOUTHLAKE BLVD STE 120332
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6634
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Country | US
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Telephone | 214-455-0579
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEEPKIA KILARU
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Credential | MD
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Telephone | 214-455-0579
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | N1365
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License Number State | TX
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