Healthcare Provider Details

I. General information

NPI: 1689588394
Provider Name (Legal Business Name): MICHAEL KLINE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 S 5TH AVE RM 4034
HINES IL
60141-3030
US

IV. Provider business mailing address

5000 S 5TH AVE RM 4034
HINES IL
60141-3030
US

V. Phone/Fax

Practice location:
  • Phone: 708-368-5058
  • Fax:
Mailing address:
  • Phone: 708-368-5058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number041419779
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: