=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124047196
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL J KAPLAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2006
-----------------------------------------------------
Last Update Date | 02/05/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1579 STRAITS TURNPIKE
-----------------------------------------------------
City | MIDDLEBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-758-1272
-----------------------------------------------------
Fax | 203-758-1070
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1579 STRAITS TURNPIKE
-----------------------------------------------------
City | MIDDLEBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-758-1272
-----------------------------------------------------
Fax | 203-758-1070
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XX0005X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
-----------------------------------------------------
License Number | 034194
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------