1316260474 NPI number — MITCHELL KAPLAN DC PA

Table of content: (NPI 1316260474)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316260474 NPI number — MITCHELL KAPLAN DC PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MITCHELL KAPLAN DC PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MITCHELL L. KAPLAN, D.C.,P.A.
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316260474
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 360914
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELBOURNE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32936-0914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-255-3003
Provider Business Mailing Address Fax Number:
321-255-3005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1565 SARNO RD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32935-5268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-255-3003
Provider Business Practice Location Address Fax Number:
321-255-3005
Provider Enumeration Date:
03/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KAPLAN
Authorized Official First Name:
MITCHELL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
321-255-3003

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH0002725 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 380957900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1205832862 . This is a "NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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