Basic Information
| Provider Information | |||||||||
| NPI: | 1962484386 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KILEY | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | OLIVER | ||||||||
| OtherFirstName: | SUSAN | ||||||||
| OtherMiddleName: | E | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9480 BRIAR VILLAGE POINT | ||||||||
| Address2: | SUITE #200 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192783627 | ||||||||
| FaxNumber: | 7196232101 | ||||||||
| Practice Location | |||||||||
| Address1: | 9480 BRIAR VILLAGE POINT | ||||||||
| Address2: | SUITE #200 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192783627 | ||||||||
| FaxNumber: | 7196232101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2005 | ||||||||
| LastUpdateDate: | 04/02/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 40891 | CO | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 702864 | 05 | CO | MEDICAID |