Organization
LOUISVILLE & SO INDIANA PULMONARY CARE PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY KILLEEN MD (MANAGER)
(502) 368-9590
Entity
Organization
Contact information
Practice address
4402 CHURCHMAN AVE, SUITE 409, LOUISVILLE, KY 40215-1190
(502) 368-9590
(502) 368-9616
Mailing address
4402 CHURCHMAN AVE, SUITE 409, LOUISVILLE, KY 40215-1190
(502) 368-9590
(502) 368-9616
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000701204
ANTHEM
KY
05
—
200926940A
—
IN
05
—
7100144810
—
KY
01
—
DR3113
RAILROAD MEDICARE
—
Enumeration date
01/09/2009
Last updated
11/10/2017
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