Individual
MR. TIMOTHY ROBERT KILLEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4606 GREENWOOD RD, LOUISVILLE, KY 40258
(502) 937-2209
Mailing address
PO BOX 776351 SUITE 305, CHICAGO, IL 60677-6351
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
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