Healthcare Provider Details

I. General information

NPI: 1245500438
Provider Name (Legal Business Name): AHMAD ALKILANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 FOREST PARK CIR
PANAMA CITY FL
32405-4915
US

IV. Provider business mailing address

PO BOX 578
LYNN HAVEN FL
32444-0578
US

V. Phone/Fax

Practice location:
  • Phone: 850-257-5524
  • Fax: 850-257-5638
Mailing address:
  • Phone: 850-257-5524
  • Fax: 850-257-5638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL.3512R
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME165501
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: