Basic Information
Provider Information
NPI: 1942228077
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KLINE
FirstName: KATHY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1221 SOUTH DR
Address2:  
City: MT PLEASANT
State: MI
PostalCode: 488583258
CountryCode: US
TelephoneNumber: 9897726700
FaxNumber: 9897726708
Practice Location
Address1: 1221 SOUTH DR
Address2:  
City: MT PLEASANT
State: MI
PostalCode: 488583258
CountryCode: US
TelephoneNumber: 9897726700
FaxNumber: 9897726708
Other Information
ProviderEnumerationDate: 07/17/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZP0105XMI4301052364MIY Allopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine

No ID Information.


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