Provider Demographics
NPI:1225023955
Name:KILIAN, KENNETH RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:RICHARD
Last Name:KILIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1390 HIGHWAY 61
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4137
Mailing Address - Country:US
Mailing Address - Phone:636-933-9300
Mailing Address - Fax:636-933-9114
Practice Address - Street 1:1390 HIGHWAY 61
Practice Address - Street 2:SUITE 2200
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4137
Practice Address - Country:US
Practice Address - Phone:636-933-9300
Practice Address - Fax:636-933-9114
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002022533207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01222334OtherRAILROAD MEDICARE
MO1225023955Medicaid
MO203307137Medicaid
MOP01222334OtherRAILROAD MEDICARE
MO203307137Medicaid