1912974387 NPI number — AHMAD KILANI MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912974387 NPI number — AHMAD KILANI MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KILANI

Provider First Name:

AHMAD

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1912974387

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

06/24/2011

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

20525 CENTER RIDGE ROAD

Provider Second Line Business Mailing Address:

SUITE 220

Provider Business Mailing Address City Name:

ROCKY RIVER

Provider Business Mailing Address State Name:

OH

Provider Business Mailing Address Postal Code:

44116

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

440-895-5056

Provider Business Mailing Address Fax Number:

440-333-2935

Provider First Line Business Practice Location Address:

20455 LORAIN RD

Provider Second Line Business Practice Location Address:

SUITE 104

Provider Business Practice Location Address City Name:

FAIRVIEW PARK

Provider Business Practice Location Address State Name:

OH

Provider Business Practice Location Address Postal Code:

44126-3494

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

440-356-2715

Provider Business Practice Location Address Fax Number:

440-356-6978

Provider Enumeration Date:

03/03/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  35074763K , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 9273172 . This is a "GROUP MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: D368301 . This is a "GROUP IND DIAGNOSTICS MED" identifier . This identifiers is of the category "OTHER".
• Identifier: F74763 . This is a "SUMMACARE APEX" identifier . This identifiers is of the category "OTHER".
• Identifier: P00022220 . This is a "RR MEDICARE INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
• Identifier: 103379 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".
• Identifier: 2173071 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 341783789030 . This is a "CARESOURCE" identifier . This identifiers is of the category "OTHER".
• Identifier: 10794077 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
• Identifier: CA4511 . This is a "RR MEDICARE GROUP" identifier . This identifiers is of the category "OTHER".
• Identifier: 7682177 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 000000286558 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
• Identifier: 0119204 . This is a "GROUP MEDICAID" identifier . This identifiers is of the category "OTHER".
• Identifier: 1782634279 . This is a "GROUP NPI" identifier . This identifiers is of the category "OTHER".
• Identifier: 3610861 . This is a "GROUP ASC MEDICARE" identifier . This identifiers is of the category "OTHER".