Healthcare Provider Details

I. General information

NPI: 1306817200
Provider Name (Legal Business Name): ELIZABETH MILLER KLINE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 DOUGHTY ST STE 280
CHARLESTON SC
29403-5727
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-720-8317
  • Fax: 843-720-8319
Mailing address:
  • Phone: 843-789-1620
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number23465
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: