MEDICARE: ROBERTA MARIE 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	207ZP0101X	Anatomic Pathology Physician	ME58665	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1245222447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTA MARIE KILLEEN MD

Provider Business Mailing Address
First Line	:	2520 US HIGHWAY 19
Second Line	:
City	:	HOLIDAY
State	:	FL
Zip	:	34691-3846
Country	:	US
Telephone Number	:	727-934-6905
Fax Number	:	727-934-4045

Provider Business Practice Location Address
First Line	:	2520 US HIGHWAY 19
Second Line	:
City	:	HOLIDAY
State	:	FL
Zip	:	34691-3846
Country	:	US
Telephone Number	:	727-934-6905
Fax Number	:	727-934-4045

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	09/19/2011

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Directions to “ ROBERTA MARIE KILLEEN MD” Practice Location

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