Provider Demographics
NPI:1487705174
Name:KILARU, VENKATA S (MD)
Entity type:Individual
Prefix:MR
First Name:VENKATA
Middle Name:S
Last Name:KILARU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1051 PROFESSIONAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532
Mailing Address - Country:US
Mailing Address - Phone:810-720-1730
Mailing Address - Fax:810-720-1736
Practice Address - Street 1:401 S BALLENGER HWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532
Practice Address - Country:US
Practice Address - Phone:810-720-1730
Practice Address - Fax:810-720-1736
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301059094207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
050B560430OtherBLUE CROSS BLUE SHIELD
0B56043018OtherPERSONAL IDENTIFICATION
223550OtherMCLAREN HEALTH ADVANTAGE
567566OtherSELECT CARE
VK059094OtherSTATE LICENSE NUMBER
050B560430OtherBLUE CARE NETWORK
223550OtherMCLAREN HEALTH PLAN
4647093OtherAETNA HEALTH CARE
AN250004OtherMCARE INC
M001301OtherTRICARE REGION 2 & 5
104146OtherGREAT LAKES HEALTH PLAN
1172870001OtherTHE WELLNESS PLAN
0996930OtherHEALTH PLUS OF MICHIGAN
MI2846890Medicaid
30946OtherCOMMUNITY CHOICE OF M1M
EM033063OtherHEALTH ALLIANCE PLAN
VK059094OtherSTATE LICENSE NUMBER
223550OtherMCLAREN HEALTH PLAN
567566OtherSELECT CARE