Provider Demographics
NPI:1194010900
Name:KILONZO, BRIAN MBATHA (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MBATHA
Last Name:KILONZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 ILLINI DR STE 408
Mailing Address - Street 2:
Mailing Address - City:SILVIS
Mailing Address - State:IL
Mailing Address - Zip Code:61282-2904
Mailing Address - Country:US
Mailing Address - Phone:309-281-2140
Mailing Address - Fax:309-281-2149
Practice Address - Street 1:855 ILLINI DR STE 408
Practice Address - Street 2:
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282-2904
Practice Address - Country:US
Practice Address - Phone:309-281-2140
Practice Address - Fax:309-281-2149
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IAR9260207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program