Provider Demographics
NPI:1023080033
Name:KILL, MATHIAS JOHN (MD)
Entity type:Individual
Prefix:
First Name:MATHIAS
Middle Name:JOHN
Last Name:KILL
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 1:2832 GRANADA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-4934
Mailing Address - Country:US
Mailing Address - Phone:619-804-4787
Mailing Address - Fax:
Practice Address - Street 1:34730 BOB WILSON DR
Practice Address - Street 2:GENERAL SURGERY DEPARTMENT
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-3098
Practice Address - Country:US
Practice Address - Phone:619-532-7575
Practice Address - Fax:619-532-7673
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75769208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery