Provider Demographics
NPI:1154305043
Name:KLAPHEKE, MARTIN M (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:M
Last Name:KLAPHEKE
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 1:6850 LAKE NONA BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7408
Mailing Address - Country:US
Mailing Address - Phone:407-266-1183
Mailing Address - Fax:
Practice Address - Street 1:6850 LAKE NONA BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7408
Practice Address - Country:US
Practice Address - Phone:407-266-1183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-04
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY309372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64309370Medicaid
KY64309370Medicaid