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General NPI Number Information
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NPI Number | 1821275355
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Entity Type | Organization
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Legal Business Name | RONALD B KILLIAN DPM LLC
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Dates
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Enumeration Date | 01/28/2008
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Last Update Date | 07/03/2009
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Provider Practice Location Address
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Address Line | 1731 MESQUITE AVE SUITE 4
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5653
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Country | US
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Telephone | 928-854-4307
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Fax | 928-854-4339
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Provider Business Mailing Address
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Address Line | PO BOX 604
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86405-0604
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Country | US
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Telephone | 928-854-4307
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Fax | 928-854-4339
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Authorized Official
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Title or Position | OWNER
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Name | DR. RONALD B. KILLIAN
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Credential | DPM
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Telephone | 928-854-4307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 0554
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License Number State | AZ
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