MEDICARE: EUGENE S KILLEAVY 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	207RC0000X	Cardiovascular Disease Physician	ME59238	FL
2	207R00000X	Internal Medicine Physician	ME59238	FL
3	207RI0011X	Interventional Cardiology Physician	ME59238	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	:	1801805916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENE S KILLEAVY MD

Provider Business Mailing Address
First Line	:	PO BOX 11406
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4005
Country	:	US
Telephone Number	:	321-452-3811
Fax Number	:	321-454-4026

Provider Business Practice Location Address
First Line	:	150 N SYKES CREEK PKWY
Second Line	:	SUITE 300
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-3488
Country	:	US
Telephone Number	:	321-452-3811
Fax Number	:	321-454-4026

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

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	09/14/2016

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Directions to “ EUGENE S KILLEAVY MD” Practice Location

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