1861591661 NPI number — DR. MARK E KAPLAN MD

Table of content: DR. MARK E KAPLAN MD (NPI 1861591661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861591661 NPI number — DR. MARK E KAPLAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAPLAN
Provider First Name:
MARK
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1861591661
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9800 SHELBYVILLE RD
Provider Second Line Business Mailing Address:
STE 220
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40223-2992
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-429-8585
Provider Business Mailing Address Fax Number:
855-656-7325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36100 N BROOKSIDE DR STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GURNEE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60031-4573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-855-1570
Provider Business Practice Location Address Fax Number:
847-855-1890
Provider Enumeration Date:
09/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207KA0200X , with the licence number:  036077766 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207K00000X , with the licence number: 036077766 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04900809 . This is a "BCBS PROVIDER ID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 030004998 . This is a "RR MEDICARE PROVIDER ID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036077766 2 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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