| Deepika Kilaru Md Pa | |
|
4100 Heritage Ave Ste 106 Grapevine TX 76051-5716 | |
| (214) 455-0579 | |
| Not Available |
| Full Name | Deepika Kilaru Md Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 4100 Heritage Ave Ste 106, Grapevine, Texas |
| Authorized Official Name and Position | Deepkia Kilaru (OWNER) |
| Authorized Official Contact | 2144550579 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Deepika Kilaru Md Pa 2600 E Southlake Blvd Ste 120332 Southlake TX 76092-6634 Ph: (214) 455-0579 | Deepika Kilaru Md Pa 4100 Heritage Ave Ste 106 Grapevine TX 76051-5716 Ph: (214) 455-0579 |
| NPI Number | 1376974345 |
|---|---|
| Provider Enumeration Date | 12/02/2013 |
| Last Update Date | 02/17/2023 |
| Medicare PECOS PAC ID | 7517197700 |
|---|---|
| Medicare Enrollment ID | O20140310001000 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376974345 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | N1365 (Texas) | Primary |
| Provider Name | Deepika Kilaru |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780836429 PECOS PAC ID: 6507929874 Enrollment ID: I20090113000316 |
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