Individual
DR. MARY KATHLEEN KLINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3380 44TH ST SW, GRANVILLE, MI 49418
(616) 685-8250
Mailing address
245 STATE ST SE, STE 1A, GRAND RAPIDS, MI 49503-4600
(616) 685-1808
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301095108
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301095108
MICHIGAN LICENSE
MI
Enumeration date
06/30/2009
Last updated
09/05/2012
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