Provider Demographics
NPI:1316910607
Name:KLAPPER, STEPHEN ROTH (MD FACS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ROTH
Last Name:KLAPPER
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11900 N PENNSYLVANIA ST
Practice Address - Street 2:SUITE 104
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4693
Practice Address - Country:US
Practice Address - Phone:317-818-1000
Practice Address - Fax:317-818-1001
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048211A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G37114Medicare UPIN
ING37114Medicare UPIN
IN176230Medicare ID - Type Unspecified
IN176230Medicare PIN
IN176230Medicare Oscar/Certification