1790770618 NPI number — WILLIAM E KAPLAN MD

Table of content: AVI BAGLEY DPT (NPI 1972029361)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790770618 NPI number — WILLIAM E KAPLAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAPLAN
Provider First Name:
WILLIAM
Provider Middle Name:
E
Provider Name Prefix Text:
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:
1790770618
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 87618, DEPT, 10243
Provider Second Line Business Mailing Address:
CLAIMS REMITTANCE
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60680-0618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-788-2021
Provider Business Mailing Address Fax Number:
312-846-1165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 E CHICAGO AVE
Provider Second Line Business Practice Location Address:
BOX 114
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60611-2991
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-227-6415
Provider Business Practice Location Address Fax Number:
312-227-9409
Provider Enumeration Date:
09/16/2005

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: 2086S0120X , with the licence number:  036-096912 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2088P0231X , with the licence number: 036050075 , 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: 1627123 . This is a "BCBS PROVIDER ID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 10046300A . This is a "MANAGED HEALTHCARE SRVCS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036050075 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025071700 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100462300A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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