Healthcare Provider Details

I. General information

NPI: 1861591661
Provider Name (Legal Business Name): MARK E KAPLAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36100 N BROOKSIDE DR STE 203
GURNEE IL
60031-4573
US

IV. Provider business mailing address

9800 SHELBYVILLE RD STE 220
LOUISVILLE KY
40223-2992
US

V. Phone/Fax

Practice location:
  • Phone: 847-855-1570
  • Fax: 847-855-1890
Mailing address:
  • Phone: 502-429-8585
  • Fax: 855-656-7325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number036077766
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number036077766
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: