Provider Demographics
NPI:1851342026
Name:KILLIAN, MICHAEL EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDWARD
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 1:900 E 30TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-3326
Mailing Address - Country:US
Mailing Address - Phone:512-476-6555
Mailing Address - Fax:512-476-5611
Practice Address - Street 1:900 E 30TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3326
Practice Address - Country:US
Practice Address - Phone:512-476-6555
Practice Address - Fax:512-476-5611
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6342207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117500203Medicaid
TX81490SOtherBLUE CROSS/BLUE SHIELD TX
TX81490SOtherBLUE CROSS/BLUE SHIELD TX
TXF27876Medicare UPIN