Basic Information
| Provider Information | |||||||||
| NPI: | 1912974387 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KILANI | ||||||||
| FirstName: | AHMAD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20525 CENTER RIDGE ROAD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | ROCKY RIVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408955056 | ||||||||
| FaxNumber: | 4403332935 | ||||||||
| Practice Location | |||||||||
| Address1: | 20455 LORAIN RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | FAIRVIEW PARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441263494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403562715 | ||||||||
| FaxNumber: | 4403566978 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2006 | ||||||||
| LastUpdateDate: | 06/24/2011 | ||||||||
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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 | 207R00000X | 35074763K | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 9273172 | 01 | GROUP MEDICARE | OTHER | D368301 | 01 | GROUP IND DIAGNOSTICS MED | OTHER | F74763 | 01 | SUMMACARE APEX | OTHER | P00022220 | 01 | RR MEDICARE INDIVIDUAL | OTHER | 103379 | 01 | KAISER | OTHER | 2173071 | 05 | OH | MEDICAID | 341783789030 | 01 | CARESOURCE | OTHER | 10794077 | 01 | CAQH | OTHER | CA4511 | 01 | RR MEDICARE GROUP | OTHER | 7682177 | 01 | AETNA | OTHER | 000000286558 | 01 | ANTHEM | OTHER | 0119204 | 01 | GROUP MEDICAID | OTHER | 1782634279 | 01 | GROUP NPI | OTHER | 3610861 | 01 | GROUP ASC MEDICARE | OTHER |