Healthcare Provider Details

I. General information

NPI: 1962484386
Provider Name (Legal Business Name): SUSAN E KILEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN E OLIVER MD

II. Dates (important events)

Enumeration Date: 11/20/2005
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9480 BRIAR VILLAGE POINT SUITE #200
COLORADO SPRINGS CO
80920
US

IV. Provider business mailing address

9480 BRIAR VILLAGE POINT SUITE #200
COLORADO SPRINGS CO
80920
US

V. Phone/Fax

Practice location:
  • Phone: 719-278-3627
  • Fax: 719-623-2101
Mailing address:
  • Phone: 719-278-3627
  • Fax: 719-623-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number40891
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: