Provider Demographics
NPI:1861476897
Name:KILAMBI, NIRMAL K (MD)
Entity Type:Individual
Prefix:
First Name:NIRMAL
Middle Name:K
Last Name:KILAMBI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1300 E ZION RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5015
Mailing Address - Country:US
Mailing Address - Phone:479-521-8980
Mailing Address - Fax:479-521-1088
Practice Address - Street 1:1300 E ZION RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5015
Practice Address - Country:US
Practice Address - Phone:479-521-8980
Practice Address - Fax:479-521-1088
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE2858208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR340018982OtherRAILROAD MEDICARE
AR19208000000OtherQUALCHOICE OF ARKANSAS
AR143846001Medicaid
AR5L871OtherARK BLUE CROSS BLUE SHIEL
AR19208000000OtherQUALCHOICE OF ARKANSAS
AR5L871Medicare PIN