Provider Demographics
NPI:1710936562
Name:CLINE, MICHAEL A (NP)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:CLINE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:FRANKLINVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14737-0021
Mailing Address - Country:US
Mailing Address - Phone:716-685-6730
Mailing Address - Fax:718-395-1571
Practice Address - Street 1:584 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-1437
Practice Address - Country:US
Practice Address - Phone:716-685-2167
Practice Address - Fax:718-395-1571
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY400736363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1012OtherMEDICARE PTAN
NY02359328Medicaid
NY02359328Medicaid