MEDICARE: DR. KENNETH CARROLL KILLEN 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	207R00000X	Internal Medicine Physician	D6054	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8F9403	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	8BM800	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1982708137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH CARROLL KILLEN MD

Provider Business Mailing Address
First Line	:	10300 N CENTRAL EXPY STE 250
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-8600
Country	:	US
Telephone Number	:	214-706-9944
Fax Number	:	214-706-9941

Provider Business Practice Location Address
First Line	:	10300 N CENTRAL EXPY STE 250
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-8600
Country	:	US
Telephone Number	:	214-706-9944
Fax Number	:	214-706-9941

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

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	01/23/2023

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Directions to “ DR. KENNETH CARROLL KILLEN MD” Practice Location

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