Provider Demographics
NPI:1689677510
Name:KLINE, GLENN B (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:B
Last Name:KLINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12606 W HOUSTON CENTER BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2790
Mailing Address - Country:US
Mailing Address - Phone:713-596-8526
Mailing Address - Fax:713-596-8560
Practice Address - Street 1:902 FROSTWOOD DR STE 302
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2428
Practice Address - Country:US
Practice Address - Phone:713-973-0051
Practice Address - Fax:713-973-7130
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH4978207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135259302Medicaid
TX2799601004OtherCIGNA
TX0738074OtherAETNA HMO
TX4072316OtherAETNA PPO
TX030004679OtherR.R. MEDICARE
TX2317954OtherBLUE LINK
TX0738074OtherAETNA HMO
TXC17954Medicare UPIN