Provider Demographics
NPI:1154061612
Name:KALERU, THANMAI
Entity Type:Individual
Prefix:
First Name:THANMAI
Middle Name:
Last Name:KALERU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:THANMAI
Other - Middle Name:
Other - Last Name:MASTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:34103 10TH CT SW
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-7403
Mailing Address - Country:US
Mailing Address - Phone:206-556-8359
Mailing Address - Fax:
Practice Address - Street 1:521 N YOUNG ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7806
Practice Address - Country:US
Practice Address - Phone:509-221-5222
Practice Address - Fax:509-221-6330
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program