1114954922 NPI number — BRIAN M KLINE MD

Table of content: BRIAN M KLINE MD (NPI 1114954922)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114954922 NPI number — BRIAN M KLINE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLINE
Provider First Name:
BRIAN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114954922
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 775383
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-5383
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-376-5315
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
815 SCHNIER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47201-2619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-375-8810
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  01021499A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000991699 . This is a "ANTHEM PIN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1790837789 . This is a "GROUP NPI" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 110164150 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200081160A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000223817 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 056544P . This is a "SIHO" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com