Individual
LOIS ARCHER KILLEWICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4502 MEDICAL DR, 3RD FLOOR, SAN ANTONIO, TX 78229-4402
(210) 358-2074
(210) 358-4779
Mailing address
7703 FLOYD CURL DR, MC7977, SAN ANTONIO, TX 78229-3901
(210) 450-9000
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
L9764
TX
2086S0102X
Surgical Critical Care Physician
L9764
TX
2086S0129X
Vascular Surgery Physician
Primary
L9764
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100476403
—
TX
01
—
100476404
MEDICAID CSHCN
TX
Enumeration date
08/31/2006
Last updated
12/05/2013
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