Individual
MR. TIMOTHY ROBERT KILLEEN
Active
Individual
MR. TIMOTHY ROBERT KILLEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
25892
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000047638
ANTHEM
—
01
—
021102300
FEDERAL BLACK LUNG
—
01
—
1048815
PASSPORT
—
05
—
200240660A
—
IN
01
—
2432232000
PASSPORT ADVANTAGE
—
01
—
611001258
HUMANA
—
05
—
64258924
—
KY
01
—
K307890
MEDICARE PTAN
KY
Enumeration date
07/13/2005
Last updated
10/23/2020
Update your record
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