Healthcare Provider Details

I. General information

NPI: 1588404974
Provider Name (Legal Business Name): LINDSAY AMANDA KLINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 FRANCISCAN WAY
MICHIGAN CITY IN
46360-0033
US

IV. Provider business mailing address

401 STURDY RD APT 124
VALPARAISO IN
46383-5274
US

V. Phone/Fax

Practice location:
  • Phone: 219-879-8511
  • Fax:
Mailing address:
  • Phone: 219-384-9181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1004593A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: