Provider Demographics
NPI:1023125440
Name:CLINE, EMILY D (MD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:D
Last Name:CLINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 W JEFFERSON ST STE S200
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2140
Mailing Address - Country:US
Mailing Address - Phone:317-738-0630
Mailing Address - Fax:317-738-0737
Practice Address - Street 1:8 N US 31 STE C
Practice Address - Street 2:
Practice Address - City:WHITELAND
Practice Address - State:IN
Practice Address - Zip Code:46184-1546
Practice Address - Country:US
Practice Address - Phone:317-530-3111
Practice Address - Fax:317-738-0737
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041659174400000X, 207VG0400X
IN01041659A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN91506OtherANTHEM
IN200068370AMedicaid
IN200068370AMedicaid
IN91506OtherANTHEM