Provider Demographics
NPI:1144276387
Name:KILLIUS, JAMES S (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:S
Last Name:KILLIUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1678
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32302-1678
Mailing Address - Country:US
Mailing Address - Phone:850-878-4102
Mailing Address - Fax:850-942-4155
Practice Address - Street 1:1600 PHILLIPS RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5304
Practice Address - Country:US
Practice Address - Phone:850-878-4127
Practice Address - Fax:850-878-0337
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME800142085N0904X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000900446CMedicaid
FL35746OtherBCBS
FL258980000Medicaid
GA000900446BMedicaid
300117833Medicare PIN
FL35746OtherBCBS
FL35746YMedicare PIN
FL35746XMedicare PIN
G95497Medicare UPIN
FL258980000Medicaid