DR. NIZAR KHERALLAH (NPI# 1669467726) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669467726 |
| Entity Type | Individual |
| Full Name | DR. NIZAR KHERALLAH |
| Credential | MD |
| Practice Address |
530 Ne Glen Oak Ave Dept Of Peoria IL 61637-2673 |
| Mailing Address |
530 Ne Glen Oak Ave Peoria IL 61637-0001 |
| Practice Telephone | 3096249844 |
| Practice Fax Number | 3096249844 |
| Mailing Telephone | 3096244542 |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0214X |
Pediatrics Specialization: Pediatric Pulmonology |
35072648 | OH | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 2122661 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2222 Cherry St, Suite 2900, Toledo, OH 436082673 | 4192516430 | 4192516433 |
| Street Address |
530 NE GLEN OAK AVE DEPT OF |
| City | PEORIA |
| State | IL |
| Zip Code | 61637-2673 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780200865 | Kuang Chuen Liu | Pediatrics | 530 Ne Glen Oak Ave, Peoria, Peoria, IL 61637 | 2020-06-24 |
| 1174184527 | Manisha Tharoor | Student in an Organized Health Care Education/Training Program | 530 N.e Glen Oak Ave, Peoria, IL 61637 | 2019-06-26 |
| 1609436724 | Sriviji Senthil Kumaran | Student in an Organized Health Care Education/Training Program | 530. N.e Glen Oak Ave., Peoria, IL 61637 | 2019-06-20 |
| 1780240929 | Abuzar Ali Asif | Student in an Organized Health Care Education/Training Program | 530 N. E. Glen Oak Ave., Peoria, IL 61637 | 2019-05-14 |
| 1518328665 | Jenna Bishop | Dietitian, Registered | 600 Ne Water Street, Peoria, IL 61637 | 2016-03-17 |
| 1194133850 | Ashish Kumar Roy | Internal Medicine | 530 N.e. Glen Oak Ave, Peoria, IL 61637 | 2014-07-25 |
| 1265720510 | Reuben Antony | Pediatrics | 530 Ne Glen Oak Ave., C/o Ms Suzy Lewellen, Peoria, IL 61637 | 2011-07-20 |
| 1366673436 | Joseph William Hauter | Emergency Medicine | 830 Ne Glen Oak Ave, Peoria, IL 61637 | 2009-08-06 |
| 1437380748 | Jeremy R Monroe | Emergency Medicine | 530 Glen Oak, Osf St Francis Medical Center, Peoria, IL 61637 | 2009-08-04 |
| 1326244682 | Maria S. Parr | Psychiatry & Neurology | Osf Saint Francis Medical Center, 530 N.e.glen Oak Ave., Peoria, FL 61637 | 2007-06-25 |
| Find all providers in zip 61637 | ||||
| Taxonomy Code | 2080P0214X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Pulmonology |
| A pediatrician dedicated to the prevention and treatment of all respiratory diseases affecting infants, children and young adults. This specialist is knowledgeable about the growth and development of the lung, assessment of respiratory function in infants and children, and experienced in a variety of invasive and noninvasive diagnostic techniques. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437593472 | Brenda Louise Giles | Pediatrics | 5721 South Maryland Avenue, Dept of Peds, K160j, Mc8000, The University of Chicago, Chicago, IL 60637 | 2013-04-22 |
| 1790913036 | Avani Vinod Shah | Pediatrics | 630 N State St Apt 1502, Chicago, IL 60654 | 2009-06-25 |
| 1891816781 | Kimberly D. Watts | Pediatrics | 2300 N Childrens Plz # 43, Chicago, IL 60614-3363 | 2007-04-02 |
| 1578612438 | Childrens Medical Center Sc | Pediatrics | 1801 W 47th St, Chicago, IL 60609-3872 | 2007-01-09 |
| 1982783361 | David Scott Shoberg | Pediatrics | 7144 Kleckner Rd, Rockford, IL 61107-6821 | 2006-11-04 |
| 1770542862 | Thomas Patrick Green | Pediatrics | 2400 Childrens Plaza, Childrens Memorial Hospital, Chicago, IL 60614 | 2006-03-20 |
| 1841701075 | Ashley Black | Pediatrics | 6501 S Promontory Dr, Chicago, IL 60649-1003 | 2017-10-16 |
| 1699188623 | John Palla | Pediatrics | 225 E Chicago Ave, Chicago, IL 60611-2991 | 2014-06-06 |
| 1083847917 | Torero Pulmonary Specialists, Sc | Pediatrics | 4440 W 95th St, Oak Lawn, IL 60453-2600 | 2009-08-26 |
| 1487809448 | Anwar Shafi | Pediatrics | 301 N 8th St, Suite Pav4a, Springfield, IL 62701-1041 | 2008-11-18 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.