Healthcare Provider Details

I. General information

NPI: 1487642708
Provider Name (Legal Business Name): KILLIAN AND ASSOCIATES SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 S 5TH ST
SPRINGFIELD IL
62703-2312
US

IV. Provider business mailing address

1020 S 5TH ST
SPRINGFIELD IL
62703-2312
US

V. Phone/Fax

Practice location:
  • Phone: 217-544-3143
  • Fax: 217-544-4436
Mailing address:
  • Phone: 217-544-3143
  • Fax: 217-544-4436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number042007661
License Number StateIL

VIII. Authorized Official

Name: TERRY M KILLIAN
Title or Position: OWNER
Credential: MD
Phone: 217-544-3143