MEDICARE: MARCUS K KILIAN PSY.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	103T00000X	Psychologist	2610-057	WI

General Provider Information

NPI Number	:	1578654992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCUS K KILIAN PSY.D.

Provider Business Mailing Address
First Line	:	1821 UNIVERSITY AVE W
Second Line	:	SUITE N385
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-2801
Country	:	US
Telephone Number	:	651-644-8515
Fax Number	:	651-644-3451

Provider Business Practice Location Address
First Line	:	1821 UNIVERSITY AVE W
Second Line	:	SUITE N385
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-2801
Country	:	US
Telephone Number	:	651-644-8515
Fax Number	:	651-644-3451

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	09/02/2008

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