Provider Demographics
NPI:1124105697
Name:KLINE, KEVIN ANDREW (DO)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ANDREW
Last Name:KLINE
Suffix:
Gender:M
Credentials:DO
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 38
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-0038
Mailing Address - Country:US
Mailing Address - Phone:812-734-3800
Mailing Address - Fax:812-734-3108
Practice Address - Street 1:1263 HOSPITAL DR NW
Practice Address - Street 2:SUITE 105
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2172
Practice Address - Country:US
Practice Address - Phone:812-734-3800
Practice Address - Fax:812-734-3108
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004998A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ044201Medicaid
AZ044201Medicaid
F08626Medicare UPIN
MO044763230Medicare PIN
MO044763230Medicare PIN