Provider Demographics
NPI:1730292020
Name:KILBANE, ANTHONY JOHN (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOHN
Last Name:KILBANE
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 1:15144 LEVAN RD STE 44
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5027
Mailing Address - Country:US
Mailing Address - Phone:734-779-2136
Mailing Address - Fax:734-779-2155
Practice Address - Street 1:15144 LEVAN RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5027
Practice Address - Country:US
Practice Address - Phone:734-779-2136
Practice Address - Fax:734-779-2155
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301052982207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF61990Medicare UPIN
MION32870Medicare ID - Type Unspecified