Healthcare Provider Details

I. General information

NPI: 1588751382
Provider Name (Legal Business Name): CARL A. KAPLAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 W 203RD ST STE 202
OLYMPIA FIELDS IL
60461-1185
US

IV. Provider business mailing address

3691 RUTGER ST. PROVIDER ENROLLMENT
ST. LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 708-679-2660
  • Fax: 708-503-3860
Mailing address:
  • Phone: 314-977-6828
  • Fax: 314-977-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number114228
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036130356
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: