Provider Demographics
NPI:1740202316
Name:KLINE, JEFFREY A (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:KLINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 W 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-639-6671
Practice Address - Fax:317-656-4216
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35398207P00000X, 2085U0001X
IN01070830207P00000X
IN01070830A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN35398Medicaid
IN201079860Medicaid
NC49681OtherNCBCBS
NC8948681Medicaid
NC930046772Medicare PIN
NC2174563CMedicare PIN
NC49681OtherNCBCBS
NCP00410601Medicare PIN
INP01141652Medicare PIN
NCF34878Medicare UPIN
IN201079860Medicaid
NC8948681Medicaid