Provider Demographics
NPI:1679632970
Name:KILLIAN, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
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 66971
Mailing Address - Street 2:MID AMERICA RADIOLOGY SC
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63166-6971
Mailing Address - Country:US
Mailing Address - Phone:303-465-0401
Mailing Address - Fax:303-404-2317
Practice Address - Street 1:400 N PLEASANT AVE
Practice Address - Street 2:RADIOLOGY DEPT
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3056
Practice Address - Country:US
Practice Address - Phone:618-436-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360848462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00357284OtherMEDICARE RAILROAD
IL036084846-1Medicaid
ILK33546Medicare PIN
IL036084846-1Medicaid
ILK33547Medicare PIN