=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750516985
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PALLAVI KAKULAVAR MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2009
-----------------------------------------------------
Last Update Date | 09/28/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 721 W MULBERRY ST
-----------------------------------------------------
City | ANGLETON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77515-9145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-536-7698
-----------------------------------------------------
Fax | 815-642-8581
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 841149
-----------------------------------------------------
City | PEARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77584-9145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-536-7698
-----------------------------------------------------
Fax | 815-642-8581
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. PALLAVI KAKULAVAR
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 281-536-7698
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | M1810
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------