Provider Demographics
NPI:1669427027
Name:KILIAN, SANDRA (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:KILIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:KIRKPATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:760 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2048
Mailing Address - Country:US
Mailing Address - Phone:517-780-9260
Mailing Address - Fax:517-780-9263
Practice Address - Street 1:760 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2048
Practice Address - Country:US
Practice Address - Phone:517-780-9260
Practice Address - Fax:517-780-9263
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301055455173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI12-20018OtherPHP OF SOUTH MICHIGAN
MI5108230OtherAETNA
MI104447698Medicaid
MI35-0-38-0136-1OtherBLUE CROSS BLUE SHIELD
MI1420OtherHEALTH PLAN OF MICHIGAN
MI110696OtherPREFERRED CHOICES
MI8414280-002OtherCIGNA