Provider Demographics
NPI:1699796631
Name:MARC A KAPLAN PLLC
Entity type:Organization
Organization Name:MARC A KAPLAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-459-0000
Mailing Address - Street 1:2585 E WILCOX DR STE C
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2822
Mailing Address - Country:US
Mailing Address - Phone:520-459-0000
Mailing Address - Fax:520-459-5141
Practice Address - Street 1:2585 E WILCOX DR STE C
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2822
Practice Address - Country:US
Practice Address - Phone:520-459-0000
Practice Address - Fax:520-459-5141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1872207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ255465Medicaid
4114163OtherAETNA
AZAZ0779310OtherBCBSAZ
4114163OtherAETNA
AZZ103269Medicare PIN
AZAZ0779310OtherBCBSAZ