Provider Demographics
NPI:1871699611
Name:UNIVERSITY PEDIATRICS LTD
Entity type:Organization
Organization Name:UNIVERSITY PEDIATRICS LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:REDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KILANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-355-8828
Mailing Address - Street 1:640 S WASHINGTON ST
Mailing Address - Street 2:SUITE #288
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6603
Mailing Address - Country:US
Mailing Address - Phone:630-355-8828
Mailing Address - Fax:630-355-8837
Practice Address - Street 1:640 S WASHINGTON ST
Practice Address - Street 2:SUITE #288
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6603
Practice Address - Country:US
Practice Address - Phone:630-355-8828
Practice Address - Fax:630-355-8837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-076152207R00000X, 208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILBK8893035OtherDEA NUMBER
ILBK8893035OtherDEA NUMBER