Healthcare Provider Details

I. General information

NPI: 1629708250
Provider Name (Legal Business Name): UPPERLINE HEALTHCARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 W SYCAMORE ST STE 150
KOKOMO IN
46901-6459
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 450
NASHVILLE TN
37205-5202
US

V. Phone/Fax

Practice location:
  • Phone: 765-450-8585
  • Fax:
Mailing address:
  • Phone: 407-219-5402
  • 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 KING
Title or Position: PRESIDENT
Credential: DPM
Phone: 401-787-0999