Basic Information
| Provider Information | |||||||||
| NPI: | 1114954922 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLINE | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2502 25TH ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472013728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123728883 | ||||||||
| FaxNumber: | 8123733266 | ||||||||
| Practice Location | |||||||||
| Address1: | 815 SCHNIER ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472012619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123758810 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 10/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 01021499A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000991699 | 01 | IN | ANTHEM PIN | OTHER | 000000223817 | 01 | ANTHEM | OTHER | 056544P | 01 | SIHO | OTHER | 1790837789 | 01 | IN | GROUP NPI | OTHER | 110164150 | 01 | IN | MEDICARE RAILROAD | OTHER | 200081160A | 05 | IN | MEDICAID |