Provider Demographics
NPI:1568411536
Name:KILLIAN, DENNIS M (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:M
Last Name:KILLIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 MADISON ST
Mailing Address - Street 2:SUITE 275
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6549
Mailing Address - Country:US
Mailing Address - Phone:815-740-1900
Mailing Address - Fax:815-725-2413
Practice Address - Street 1:301 MADISON ST STE 207
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6654
Practice Address - Country:US
Practice Address - Phone:815-740-1900
Practice Address - Fax:815-725-2413
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036070597207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036070597Medicaid
ILL55715Medicare PIN
ILC51401Medicare UPIN
IL036070597Medicaid
ILL60201Medicare PIN
ILK18691Medicare PIN