Provider Demographics
NPI:1235104985
Name:KILARU, SASIDHAR P (MD)
Entity Type:Individual
Prefix:DR
First Name:SASIDHAR
Middle Name:P
Last Name:KILARU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SASHI
Other - Middle Name:P
Other - Last Name:KILARU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5885 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-1691
Mailing Address - Country:US
Mailing Address - Phone:513-541-0700
Mailing Address - Fax:513-541-2530
Practice Address - Street 1:5885 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-1691
Practice Address - Country:US
Practice Address - Phone:513-541-0700
Practice Address - Fax:513-541-2530
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37924174400000X
OH35082964208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No174400000XOther Service ProvidersSpecialist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2418842Medicaid
IN200481940AMedicaid
KY7100056850Medicaid
OHP00058512OtherRAILROAD MEDICARE
OHP00173109OtherRR MEDICARE
KYP00629656OtherRAILROAD MEDICARE
KY64082308Medicaid
OHP00058512OtherRAILROAD MEDICARE
OH2418842Medicaid
KY1459519Medicare PIN
OHP00173109OtherRR MEDICARE
IN200481940AMedicaid
KYP00629656Medicare PIN