Healthcare Provider Details

I. General information

NPI: 1992370670
Provider Name (Legal Business Name): UPPERLINE HEALTHCARE CALIFORNIA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 05/25/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 W OLIVE AVE
BURBANK CA
91502-1825
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 450
NASHVILLE TN
37205-5202
US

V. Phone/Fax

Practice location:
  • Phone: 818-848-5583
  • Fax:
Mailing address:
  • Phone: 615-627-2193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J KING
Title or Position: PRESIDENT
Credential:
Phone: 508-679-5700