Basic Information
| Provider Information | |||||||||
| NPI: | 1730745720 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLINE | ||||||||
| FirstName: | NOAH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 E. MEDICAL CTR DR | ||||||||
| Address2: | D3230 MPB | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095718 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 E. MEDICAL CTR DR | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346471774 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2019 | ||||||||
| LastUpdateDate: | 05/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 4351044321 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 4351044321 | 01 | MI | LIMITED EDUCATION LICENSE | OTHER | 5315205447 | 01 | MI | CONTROLLED SUBSTANCE LICENSE | OTHER |