Provider Demographics
NPI:1831290253
Name:KILARU, SHREE DEVI (DO)
Entity Type:Individual
Prefix:DR
First Name:SHREE
Middle Name:DEVI
Last Name:KILARU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SHREE
Other - Middle Name:KILARU
Other - Last Name:IYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1455 S LAPEER RD
Mailing Address - Street 2:STE 100
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1468
Mailing Address - Country:US
Mailing Address - Phone:248-835-8358
Mailing Address - Fax:
Practice Address - Street 1:1455 S LAPEER RD STE 100
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-1468
Practice Address - Country:US
Practice Address - Phone:248-693-3551
Practice Address - Fax:248-693-4643
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015630207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0805631814OtherBCN IND
MI0805631814OtherBCBS IND
MIP00944358OtherRAILROAD MEDICARE IND PIN
MIP00944358OtherRAILROAD MEDICARE IND PIN