Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 8645 | IN |
Y | 213EG0000X | General Practice | 8645 | IN |
NPI | 1003835992 |
---|---|
Provider Name | Kevin L Klinedinst |
First Address | Madison, IN 47250-2410 |
Second Address | Madison, IN 47250-2410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 08/07/2007 |