Healthcare Provider Details

I. General information

NPI: 1275654659
Provider Name (Legal Business Name): ROBERT M. KAPLAN M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13101 ALLEN RD
SOUTHGATE MI
48195-2216
US

IV. Provider business mailing address

13101 ALLEN ROAD
SOUTHGATE MI
48195
US

V. Phone/Fax

Practice location:
  • Phone: 313-388-4630
  • Fax: 313-388-0472
Mailing address:
  • Phone: 313-388-4630
  • Fax: 313-388-0472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301007952
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: