Basic Information
| Provider Information | |||||||||
| NPI: | 1689631079 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KILANI | ||||||||
| FirstName: | RAMZI | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 HADDONFIELD BERLIN RD STE 210 | ||||||||
| Address2: | |||||||||
| City: | VOORHEES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080433520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567822212 | ||||||||
| FaxNumber: | 8567822266 | ||||||||
| Practice Location | |||||||||
| Address1: | 221 NE GLEN OAK AVE | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 616364619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3096725522 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2006 | ||||||||
| LastUpdateDate: | 02/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | 2000167732 | MO | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036085067 | 05 | IL | MEDICAID | 2000167732 | 01 | MO | MO LICENSE | OTHER |