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NPI Code Detail

MEDICARE: OSSAMA IKLADIOS MD

MEDICARE: OSSAMA IKLADIOS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician036126039IL
2207RC0200XCritical Care Medicine (Internal Medicine) Physician036126039IL
3207RS0012XSleep Medicine (Internal Medicine) Physician036126039IL
42084A2900XNeurocritical Care Physician036126039IL
5207RP1001XPulmonary Disease Physician036126039IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316991193
Entity Type Code : Individual
Provider Name (Legal Business Name) : OSSAMA IKLADIOS MD
Provider Business Mailing Address
First Line : 1001 MAIN ST
Second Line : SUITE 200
City : PEORIA
State : IL
Zip : 61606-1907
Country : US
Telephone Number : 309-672-5682
Fax Number : 309-672-3147
Provider Business Practice Location Address
First Line : 1001 MAIN ST
Second Line : SUITE 200
City : PEORIA
State : IL
Zip : 61606-1907
Country : US
Telephone Number : 309-672-5682
Fax Number : 309-672-3147
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2006
Last Update Date : 03/18/2025

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Directions to “ OSSAMA IKLADIOS MD” Practice Location

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