Basic Information
| Provider Information | |||||||||
| NPI: | 1851383012 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLINESTIVER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 129 | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461400129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174686270 | ||||||||
| FaxNumber: | 3174686268 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MEMORIAL SQ STE 305 | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461403308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174626662 | ||||||||
| FaxNumber: | 3174686275 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2005 | ||||||||
| LastUpdateDate: | 10/08/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 01058321A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | 01058321A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 5776405 | 01 | IN | AENTA PIN# | OTHER | 200311740HB | 05 | IN | MEDICAID | 110215613 | 01 | IN | MEDICARE RAILROAD # | OTHER | 0000112526 | 01 | IN | ANTHEM PIN# | OTHER | 200118010 | 05 | IN | MEDICAID |