Ramesh Chandra Kilaru, M.D

Key facts

NPI

1083613764

Entity type

Individual (NPI type 1)

Primary specialty

Family Medicine Physician 207Q00000X

License

4301060436 (MI)

Practice address

2845 Meadowood LN
Bloomfield, MI 48302-1031

Phone

(313) 585-8646

Fax

(248) 731-8571

NPI assigned

Jul 15, 2005

Sex

Male

Sole proprietor

Yes

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Downriver Community Services, Inc. Federally Qualified Health Center (FQHC) · Port Huron, MI · NPI 1184935488
  NPD (past) FAMILY MEDICINE
• Embrace Home Health Physicians Family Medicine Physician · Southfield, MI · NPI 1598779282
  NPD (past) FAMILY MEDICINE
• Embrace Home Physicians PLLC Internal Medicine Physician · Southfield, MI · NPI 1548704778
  NPD (past)
• Macomb Family Services, Inc. Clinical Social Worker · Clinton Township, MI · NPI 1831190701
  NPD (past)
• Medical Care of Michigan LLC Geriatric Medicine (Internal Medicine) Physician · Detroit, MI · NPI 1962572404
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

State licenses

Practice roles

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 5, 2009.

{
    "created_epoch": "1121385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257379200000",
    "number": "1083613764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 W KIRBY ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482024044",
            "telephone_number": "313-585-8646",
            "fax_number": "248-731-8571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2845 MEADOWOOD LN",
            "city": "BLOOMFIELD",
            "state": "MI",
            "postal_code": "483021031",
            "telephone_number": "313-585-8646",
            "fax_number": "248-731-8571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KILARU",
        "first_name": "RAMESH",
        "middle_name": "CHANDRA",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-15",
        "last_updated": "2009-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301060436",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BSM GROUP",
            "identifier": "700B510700",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Bloomfield, MI · Family Medicine Physician in Michigan