Provider Demographics
NPI:1780836429
Name:KILARU, DEEPIKA (MD)
Entity Type:Individual
Prefix:
First Name:DEEPIKA
Middle Name:
Last Name:KILARU
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 1:4100 HERITAGE AVE
Mailing Address - Street 2:STE 106
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-5716
Mailing Address - Country:US
Mailing Address - Phone:214-455-0579
Mailing Address - Fax:817-283-1116
Practice Address - Street 1:1363 E DOVE RD
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-3904
Practice Address - Country:US
Practice Address - Phone:214-455-0579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD434720207R00000X
TXN1365207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX334385YX5QMedicare PIN
TX8L5214Medicare PIN