Provider Demographics
NPI:1154426849
Name:KILLEEN, TIMOTHY J (MD INC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:KILLEEN
Suffix:
Gender:M
Credentials:MD INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29645 RANCHO CALIFORNIA RD
Mailing Address - Street 2:226
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5211
Mailing Address - Country:US
Mailing Address - Phone:951-694-4304
Mailing Address - Fax:951-694-4307
Practice Address - Street 1:29645 RANCHO CALIFORNIA RD
Practice Address - Street 2:226
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5211
Practice Address - Country:US
Practice Address - Phone:951-694-4304
Practice Address - Fax:951-694-4307
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55364207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G553640Medicare ID - Type Unspecified
A52932Medicare UPIN