Healthcare Provider Details

I. General information

NPI: 1871699611
Provider Name (Legal Business Name): UNIVERSITY PEDIATRICS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S WASHINGTON ST SUITE #288
NAPERVILLE IL
60540-6603
US

IV. Provider business mailing address

640 S WASHINGTON ST SUITE #288
NAPERVILLE IL
60540-6603
US

V. Phone/Fax

Practice location:
  • Phone: 630-355-8828
  • Fax: 630-355-8837
Mailing address:
  • Phone: 630-355-8828
  • Fax: 630-355-8837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-076152
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-076152
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036-076152
License Number StateIL

VIII. Authorized Official

Name: DR. REDA KILANI
Title or Position: PHYSICAN
Credential: M.D.
Phone: 630-355-8828