Provider Demographics
NPI:1831127026
Name:KILLE, BRIAN N (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:N
Last Name:KILLE
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 1:220 FORTDALE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35037-1502
Mailing Address - Country:US
Mailing Address - Phone:334-382-1400
Mailing Address - Fax:334-383-0661
Practice Address - Street 1:220 FORTDALE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037-1502
Practice Address - Country:US
Practice Address - Phone:334-382-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL264213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL890014950Medicaid
AL890015109Medicaid
AL051003390OtherBC MONTGOMERY OFFICE
AL890015080Medicaid
AL890015810Medicaid
AL051116094OtherBCBS
AL128457Medicaid
AL051531789OtherBC SEVERAL LOCATIONS
AL890015100Medicaid
AL051532379OtherBC ORCHARD HEALTHCARE
AL890014980Medicaid
AL890015100Medicaid
AL051003390OtherBC MONTGOMERY OFFICE
AL051532379OtherBC ORCHARD HEALTHCARE
AL890015109Medicaid