Provider Demographics
NPI:1619959715
Name:KLINE, JOANN VICTORIA (DPM)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:VICTORIA
Last Name:KLINE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:JOANN
Other - Middle Name:VICTORIA
Other - Last Name:GUZIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3301 S ALAMEDA ST
Mailing Address - Street 2:SUITE # 306
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1882
Mailing Address - Country:US
Mailing Address - Phone:361-884-3984
Mailing Address - Fax:361-452-3262
Practice Address - Street 1:3301 S ALAMEDA ST STE 306
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411
Practice Address - Country:US
Practice Address - Phone:361-884-3984
Practice Address - Fax:361-452-3262
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1211213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U36386Medicare UPIN
00J45PMedicare ID - Type Unspecified
TX018740301Medicaid