Basic Information
| Provider Information | |||||||||
| NPI: | 1710229166 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KILEY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | LEO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3551 ROGER BROOKE DR. | ||||||||
| Address2: | INFECTIOUS DISEASE | ||||||||
| City: | JBSA-FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782344504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109165554 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3551 ROGER BROOKE DR. | ||||||||
| Address2: | |||||||||
| City: | JBSA-FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782344504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109165554 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2013 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 28478 | NE | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 28478 | NE | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.