MEDICARE: DR. OLIVIA KILLEEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207WX0110X	Pediatric Ophthalmology and Strabismus Specialist Physician	76170	MN

General Provider Information

NPI Number	:	1225560576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLIVIA KILLEEN MD

Provider Business Mailing Address
First Line	:	3900 PARK NICOLLET BLVD
Second Line	:
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55416-2503
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 PARK NICOLLET BLVD
Second Line	:
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55416-2503
Country	:	US
Telephone Number	:	952-993-3150
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2017
Last Update Date	:	06/15/2025

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