Dr Nizar Kherallah, MD | |
530 Ne Glen Oak Ave Dept Of, Peoria, IL 61637-2673 | |
(309) 624-9844 | |
(309) 624-9844 |
Full Name | Dr Nizar Kherallah |
---|---|
Gender | Male |
Speciality | Pediatrics - Pediatric Pulmonology |
Location | 530 Ne Glen Oak Ave Dept Of, Peoria, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1669467726 | NPI | - | NPPES |
2122661 | Medicaid | OH |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2080P0214X | Pediatrics - Pediatric Pulmonology | 35072648 (Ohio) | Primary |
Entity Name | The Board Of Trustees Of The University Of Illinois |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1386863819 PECOS PAC ID: 3072422716 Enrollment ID: O20031112000158 |
Mailing Address | Practice Location Address |
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Dr Nizar Kherallah, MD 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 Ph: (309) 624-4542 | Dr Nizar Kherallah, MD 530 Ne Glen Oak Ave Dept Of, Peoria, IL 61637-2673 Ph: (309) 624-9844 |
Thomas James Mcmorrow, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-2553 Fax: 309-655-2602 | |
Jessica Ford-davis, D.O. Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-2274 | |
Kelsey Elizabeth Grimes, DO Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-2000 | |
Jessica N Mistretta, DO Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-2000 | |
Mrs. Valeria Claudia Benavides Lopez, M.D., M.P.H. Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-624-3313 | |
Khalid Al Katranji, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-7171 | |
Dr. Gretchen L Kopec, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-624-0615 |