Individual
CHARLES D CLINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
111 E WISCONSIN AVE, SUITE 2000, MILWAUKEE, WI 53202-4815
(414) 290-6720
(414) 290-6755
Mailing address
111 E WISCONSIN AVE, SUITE 2000, MILWAUKEE, WI 53202-4815
(414) 290-6720
(414) 290-6755
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
713-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42938900
—
WI
01
—
970012479
MEDICARE RAILROAD
WI
01
—
970012480
MEDICARE RAILROAD
WI
Enumeration date
06/27/2006
Last updated
02/13/2009
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