Provider Demographics
NPI:1699883009
Name:KILEY, JEFFREY PHILLIP (DPM)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:PHILLIP
Last Name:KILEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 S 144TH ST STE 212
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5253
Mailing Address - Country:US
Mailing Address - Phone:402-609-3000
Mailing Address - Fax:402-609-2174
Practice Address - Street 1:1260 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-5245
Practice Address - Country:US
Practice Address - Phone:402-609-3000
Practice Address - Fax:402-609-3808
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE303213E00000X, 213ES0103X
IA00666213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0429761OtherMEDICAID GROUP NUMBER
IA0295402Medicaid
IA19837OtherMEDICARE GROUP NUMBER
IA35493OtherBC/BS
IA0429761OtherMEDICAID GROUP NUMBER
IA0295402Medicaid