Provider Demographics
NPI:1184615841
Name:KLINE, JOSHUA D (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:D
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 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5693 YMCA PARK DR W
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835-3280
Practice Address - Country:US
Practice Address - Phone:260-469-6603
Practice Address - Fax:260-486-6123
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059437A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200168080Medicaid
IN000000595581OtherANTHEM
INPOO465470OtherRAILROAD MEDICARE UPIN
INI19445Medicare UPIN
IN070880ZMedicare PIN
IN200168080Medicaid
INPOO465470OtherRAILROAD MEDICARE UPIN