Provider Demographics
NPI:1073872099
Name:DR. ROB KILLIAN
Entity type:Organization
Organization Name:DR. ROB KILLIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:KILLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-568-6320
Mailing Address - Street 1:901 BOREN AVE STE 712
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3301
Mailing Address - Country:US
Mailing Address - Phone:206-568-6320
Mailing Address - Fax:206-329-2092
Practice Address - Street 1:901 BOREN AVE STE 712
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3301
Practice Address - Country:US
Practice Address - Phone:206-568-6320
Practice Address - Fax:206-329-2092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603198284261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG28134Medicare UPIN