Provider Demographics
NPI:1780764050
Name:KILLIAN, JAMES M (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:M
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 1:6501 FANNIN ST STE NB336
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2703
Mailing Address - Country:US
Mailing Address - Phone:713-798-5983
Mailing Address - Fax:713-798-8827
Practice Address - Street 1:6501 FANNIN ST
Practice Address - Street 2:NB 336
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2703
Practice Address - Country:US
Practice Address - Phone:713-798-4072
Practice Address - Fax:713-798-3854
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD64712084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128879704Medicaid
TX128879706Medicaid
C17862Medicare UPIN
8D3109Medicare PIN
TX128879704Medicaid
130019976Medicare PIN
824641Medicare PIN