Provider Demographics
NPI:1912974387
Name:KILANI, AHMAD (MD)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:
Last Name:KILANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20525 CENTER RIDGE ROAD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116
Mailing Address - Country:US
Mailing Address - Phone:440-895-5056
Mailing Address - Fax:440-333-2935
Practice Address - Street 1:20455 LORAIN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-3494
Practice Address - Country:US
Practice Address - Phone:440-356-2715
Practice Address - Fax:440-356-6978
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35074763K207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
9273172OtherGROUP MEDICARE
D368301OtherGROUP IND DIAGNOSTICS MED
F74763OtherSUMMACARE APEX
P00022220OtherRR MEDICARE INDIVIDUAL
103379OtherKAISER
OH2173071Medicaid
341783789030OtherCARESOURCE
10794077OtherCAQH
CA4511OtherRR MEDICARE GROUP
7682177OtherAETNA
000000286558OtherANTHEM
0119204OtherGROUP MEDICAID
1782634279OtherGROUP NPI
3610861OtherGROUP ASC MEDICARE
7682177OtherAETNA
103379OtherKAISER
34-1783789OtherGROUP TIN