MEDICARE: DR. KENNETH RICHARD KILIAN M.D.

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	207Q00000X	Family Medicine Physician	2002022533	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01222334	OTHER	MO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225023955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH RICHARD KILIAN M.D.

Provider Business Mailing Address
First Line	:	1390 HIGHWAY 61
Second Line	:	SUITE 2200
City	:	FESTUS
State	:	MO
Zip	:	63028-4137
Country	:	US
Telephone Number	:	636-933-9300
Fax Number	:	636-933-9114

Provider Business Practice Location Address
First Line	:	1390 HIGHWAY 61
Second Line	:	SUITE 2200
City	:	FESTUS
State	:	MO
Zip	:	63028-4137
Country	:	US
Telephone Number	:	636-933-9300
Fax Number	:	636-933-9114

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	04/10/2015

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Directions to “ DR. KENNETH RICHARD KILIAN M.D.” Practice Location

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