Healthcare Provider Details

I. General information

NPI: 1154817864
Provider Name (Legal Business Name): DALE M KAPLAN DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4311 BAYOU BLVD APT A8
PENSACOLA FL
32503-2621
US

IV. Provider business mailing address

882 W SUNSET STRIP DR
BEVERLY HILLS FL
34465-8745
US

V. Phone/Fax

Practice location:
  • Phone: 248-931-0910
  • Fax:
Mailing address:
  • Phone: 248-931-0910
  • Fax: 727-573-2048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3976
License Number StateFL

VIII. Authorized Official

Name: DALE M KAPLAN
Title or Position: SOLE MBR
Credential: DPM
Phone: 248-931-0910