Provider Demographics
NPI:1417946708
Name:KILLIAN, LUKE MARTIN (MD)
Entity Type:Individual
Prefix:MR
First Name:LUKE
Middle Name:MARTIN
Last Name:KILLIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 633
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:TX
Mailing Address - Zip Code:76531-0633
Mailing Address - Country:US
Mailing Address - Phone:254-386-1700
Mailing Address - Fax:254-386-4950
Practice Address - Street 1:303 N BROWN ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:TX
Practice Address - Zip Code:76531-1515
Practice Address - Country:US
Practice Address - Phone:254-386-1700
Practice Address - Fax:254-386-4950
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8778207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX043971302Medicaid
G80513Medicare UPIN
8B9672Medicare ID - Type Unspecified