Individual
DR. NIZAR KHERALLAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
530 NE GLEN OAK AVE DEPT OF, PEORIA, IL 61637-2673
(309) 624-9844
(309) 624-9844
Mailing address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 624-4542
Taxonomy
Speciality
Code
Description
License number
State
2080P0214X
Pediatric Pulmonology Physician
Primary
35072648
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2122661
—
OH
Enumeration date
09/15/2005
Last updated
03/17/2018
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