Individual provider Active NPI

Kevin Chibouzo Ilo, M.D.

  • Orthopaedic Surgery Physician
  • Williamsville, NY
National Provider Identifier
1366124166
Registry record updated Jul 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
343150 Issued in NY
Practice address
111 N Maplemere Rd Ste 100
Williamsville, NY 14221-3182
Phone
(716) 204-3200
Fax
(716) 204-4337
NPI assigned
Aug 2, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 343150 NY Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

111 N Maplemere Rd Ste 100
Williamsville, NY 14221-3182

Mailing address

4225 Genesee St Ste 400
Cheektowaga, NY 14225-1994
Phone (716) 204-3200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Other, 2011
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1400 SW 5TH Ave
FL 5
Portland, OR 97201-5509

1838 9TH St
Santa Monica, CA 90404-4529

1838 9TH St Apt
Suite 202
Santa Monica, CA 90404-4531

4225 Genesee St
Suite 400
Cheektowaga, NY 14225-1994

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement14
Knee replacement24

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
SPI829CAMDOrthopaedic Surgery Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1690934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785110400000",
    "number": "1366124166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4225 GENESEE ST STE 400",
            "city": "CHEEKTOWAGA",
            "state": "NY",
            "postal_code": "142251994",
            "telephone_number": "716-204-3200",
            "fax_number": "716-204-4337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 N MAPLEMERE RD STE 100",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142213182",
            "telephone_number": "716-204-3200",
            "fax_number": "716-204-4337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILO",
        "first_name": "KEVIN",
        "middle_name": "CHIBOUZO",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-02",
        "last_updated": "2026-07-27",
        "certification_date": "2026-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NY",
            "license": "343150",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsville, NY

Sources for this page

Verify at the official NPI Registry.