Provider Demographics
NPI:1811100043
Name:KALIN, ANDREW (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:KALIN
Suffix:
Gender:
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:PO BOX 834
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46515-0834
Mailing Address - Country:US
Mailing Address - Phone:574-364-2592
Mailing Address - Fax:
Practice Address - Street 1:1824 DORCHESTER CT STE A
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-6819
Practice Address - Country:US
Practice Address - Phone:574-534-2548
Practice Address - Fax:574-534-3622
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01084267A207LP2900X
OH35.092335207L00000X, 208VP0014X
IL036136823208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3108452Medicaid
IL3108452Medicaid
IL3108452Medicaid
OHKAH003320Medicare PIN