Provider Demographics
NPI:1750516985
Name:PALLAVI KAKULAVAR MD PA
Entity type:Organization
Organization Name:PALLAVI KAKULAVAR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PALLAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKULAVAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-536-7698
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:281-536-7698
Mailing Address - Fax:815-642-8581
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1810207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216617501Medicaid
TX0088SUOtherBCBS
TXDQ1990OtherPALMETTO GPA RAILROAD MEDICARE
TXDQ1990OtherPALMETTO GPA RAILROAD MEDICARE