Individual
JOHANNA ELAINE KILLIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
300 E MAIDEN LN, SAINT JOSEPH, MI 49085-8516
(269) 429-7546
(269) 429-0807
Mailing address
300 E MAIDEN LN, SAINT JOSEPH, MI 49085-8516
(269) 429-7546
(269) 429-0807
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601003414
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0A10115
BCBSM GROUP
MI
01
—
1531892018
GROUP NPI
MI
01
—
CG9582
PALMETTO GBA GROUP
MI
Enumeration date
08/31/2006
Last updated
02/25/2010
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