Provider Demographics
NPI:1225023930
Name:KILLIAN, KEVIN LEE (DPM)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LEE
Last Name:KILLIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:534 WEST JOHN STREET
Mailing Address - Street 2:M AND L PODIATRY
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105
Mailing Address - Country:US
Mailing Address - Phone:704-847-9788
Mailing Address - Fax:704-849-2928
Practice Address - Street 1:534 WEST JOHN STREET
Practice Address - Street 2:MATTHEWS FOOT CARE
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105
Practice Address - Country:US
Practice Address - Phone:704-847-9788
Practice Address - Fax:704-849-2928
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC312213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC312OtherSTATE LICENSE
NC890806NMedicaid
U33557Medicare UPIN
NC2432792Medicare ID - Type Unspecified