Provider Demographics
NPI:1588751382
Name:KAPLAN, CARL A (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:A
Last Name:KAPLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3691 RUTGER ST.
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110
Mailing Address - Country:US
Mailing Address - Phone:314-977-6828
Mailing Address - Fax:314-977-6777
Practice Address - Street 1:3800 W 203RD ST STE 202
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1185
Practice Address - Country:US
Practice Address - Phone:708-679-2660
Practice Address - Fax:708-503-3860
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114228207RP1001X
IL036130356207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209678804Medicaid
MO908100247Medicare ID - Type Unspecified
MO209678804Medicaid