Individual
RANDALL I KLINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
211 N EDDY ST, SOUTH BEND, IN 46617-3096
(574) 247-4667
(574) 271-4458
Mailing address
211 N EDDY ST, SOUTH BEND, IN 46617-3096
(574) 247-4667
(574) 271-4458
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
07000940A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000891332
ANTHEM BCBS
IN
01
—
07000940A
LICENSE
IN
05
—
200471400
—
IN
01
—
P00131601
RR MEDICARE
GA
Enumeration date
09/20/2005
Last updated
03/21/2023
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