Healthcare Provider Details

I. General information

NPI: 1790770618
Provider Name (Legal Business Name): WILLIAM E KAPLAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE BOX 114
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

PO BOX 87618, DEPT, 10243 CLAIMS REMITTANCE
CHICAGO IL
60680-0618
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-6415
  • Fax: 312-227-9409
Mailing address:
  • Phone: 312-788-2021
  • Fax: 312-846-1165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number036-096912
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number036050075
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: