Provider Demographics
NPI:1417942137
Name:KILLIAN, BRIAN LAMAR (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LAMAR
Last Name:KILLIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:M AND L PODIATRY
Mailing Address - Street 2:526 WEST JOHN STREET
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5353
Mailing Address - Country:US
Mailing Address - Phone:704-847-9788
Mailing Address - Fax:704-849-2928
Practice Address - Street 1:MATTHEWS FOOT CARE
Practice Address - Street 2:526 WEST JOHN STREET
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5353
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:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC367213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890804CMedicaid
NC367OtherSTATE LICENSE
NC2432792Medicare ID - Type Unspecified
NC890804CMedicaid