MEDICARE: MR. DONALD LEE KLINE CSA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1518947043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONALD LEE KLINE CSA

Provider Business Mailing Address
First Line	:	18504 NELSON RD
Second Line	:
City	:	COVINGTON
State	:	LA
Zip	:	70435-8034
Country	:	US
Telephone Number	:	985-285-9035
Fax Number	:	985-276-4813

Provider Business Practice Location Address
First Line	:	18504 NELSON RD
Second Line	:
City	:	COVINGTON
State	:	LA
Zip	:	70435-8034
Country	:	US
Telephone Number	:	985-285-9035
Fax Number	:	985-276-4813

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	09/02/2014

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