Provider Demographics
NPI:1649230087
Name:KAKULAVAR, PALLAVI (MD)
Entity Type:Individual
Prefix:
First Name:PALLAVI
Middle Name:
Last Name:KAKULAVAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 841149
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-9145
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:721 W. MULBERRY ST.
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-9145
Practice Address - Country:US
Practice Address - Phone:281-536-7698
Practice Address - Fax:815-642-8581
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1810207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CD607OtherBCBS
TX175943302Medicaid
TXP00821763OtherPALMETTO GPA-RAILROAD MEDICARE
TX8CD607OtherBCBS
TX175943302Medicaid